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

• 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
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2022.02.050

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.