Comparing costs of standard Breast-Conserving Surgery to Oncoplastic Breast-Conserving Surgery and Mastectomy with Immediate two-stage Implant-Based Breast Reconstruction

Conventional breast-conserving surgery (C-BCS) has equal oncological outcomes and superior cosmetic and patient-reported outcomes compared to mastectomy with immediate two-stage implant-based breast reconstruction (M-IBR). Oncoplastic breast-conserving surgery (OP-BCS) is increasingly being used, as...

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Published in:	Journal of plastic, reconstructive & aesthetic surgery Vol. 75; no. 8; pp. 2569 - 2576
Main Authors:	Witmer, Tom J.K., Kouwenberg, Casimir A.E., Bargon, Claudia A., de Leeuw, Daniëlle M., Koiter, Eveline, Siemerink, Ester J.M., Mureau, Marc A.M., Rakhorst, Hinne A.
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Ltd 01-08-2022
Subjects:	Breast Cancer Breast Reconstruction Breast-Conserving Surgery Complications Costs Oncoplastic Breast-Conserving Surgery Breast-Conserving Surgery Costs PROs PORT Complications ZGT ADM Oncoplastic Breast-Conserving Surgery M-IBR IQR Breast Cancer C-BCS OP-BCS Breast Reconstruction SD BCS NZa DCIS QALY BMI ERAS
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Summary:	Conventional breast-conserving surgery (C-BCS) has equal oncological outcomes and superior cosmetic and patient-reported outcomes compared to mastectomy with immediate two-stage implant-based breast reconstruction (M-IBR). Oncoplastic breast-conserving surgery (OP-BCS) is increasingly being used, as it often has better cosmetic results and it enables larger tumour resection. However, OP-BCS and M-IBR compared to C-BCS lengthens operative time and might lead to more complications and consequently to additional costs. Therefore, this study aimed to compare costs and complication rates of C-BCS, OP-BCS and M-IBR. This single-centre, retrospective cohort study, calculated costs for all patients who had undergone breast cancer surgery between January 2014 and December 2016. Patient-, tumour- and surgery-related data of C-BCS, OP-BCS and M-IBR patients were retrieved by medical record review. Treatment costs were calculated using hospital financial data. Differences in costs and complications were analysed. A total of 220 patients were included: 74 patients in the C-BCS, 78 in the OP-BCS and 68 in the M-IBR group. From most expensive to least expensive, differences in total costs were found between C-BCS vs. OP-BCS and C-BCS vs. M-IBR (p=<0.01 and p=0.04, respectively). Costs of OP-BCS and M-IBR were comparable. Complication rates were 5.5% for C-BCS, followed by 17% for OP-BCS, and 34% for M-IBR (p<0.01). Considering total treatment costs, OP-BCS was financially non-inferior to M-IBR, whereas complication rates were higher following M-IBR. Therefore, when considering other benefits of OP-BCS, such as higher patient-reported outcomes and similar oncological outcomes, a shift from M-IBR to BCS using oncoplastic techniques seems justified.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1748-6815 1878-0539
DOI:	10.1016/j.bjps.2022.02.050