Cumulative Medical Costs of Prepectoral Versus Subpectoral Implant-based Breast Reconstruction: A Single-Center Retrospective Analysis.

BACKGROUND

Prepectoral implant-based breast reconstruction may enhance aesthetic results and improve functional outcomes. Although currently favored over other approaches, the use of acellular dermal matrices may lead to higher healthcare costs compared with the subpectoral approaches. Prior research on the cost implications often lacks comprehensive analyses of cumulative perioperative medical expenses.

METHODS

This retrospective cohort study analyzed data from women who underwent unilateral or bilateral mastectomy followed by immediate implant-based reconstruction at a single academic center between July 2017 and June 2022. We used financial data to examine billing charges from the index surgery and the downstream costs of patient care up to 6 months postoperation. Regression analyses assessed total index surgery costs, downstream costs, and cumulative costs while adjusting for variables such as age, body mass index, and racial demographics.

RESULTS

The study analyzed data from 86 prepectoral and 99 subpectoral reconstruction patients. Subpectoral reconstructions had significantly lower index surgery costs, including a 30.5% decrease in costs compared with prepectoral reconstruction (P < 0.001). Although downstream costs up to 6 months postsurgery did not significantly differ, cumulative costs were 29.2% lower in subpectoral cases (P < 0.001). The increased use of acellular dermal matrix in prepectoral procedures contributed to higher costs.

CONCLUSIONS

Prepectoral implant-based reconstruction is associated with significantly higher surgical and cumulative costs compared with subpectoral reconstruction. These results provide critical cost-related insights as prepectoral techniques gain traction. Addressing these cost variables could facilitate broader implementation of prepectoral procedures, leveraging their potential patient-centered benefits.