The Price of Aesthetics After Nipple-Sparring Mastectomy: A Cost-Minimization Analysis of Skin Banking With Deep Inferior Epigastric Perforator Flap.
The Price of Aesthetics After Nipple-Sparring Mastectomy: A Cost-Minimization Analysis of Skin Banking With Deep Inferior Epigastric Perforator Flap.
- 2020
BACKGROUND: Skin necrosis after nipple-sparing mastectomy (NSM) and deep inferior epigastric perforator (DIEP) breast reconstruction impacts cosmesis and patient satisfaction. Skin grafting might mitigate these sequelae, but oftentimes creates a color and texture mismatch with native breast skin. In contrast, abdominal skin on the DIEP flap is an excellent match and can be banked. The purposes of this study are to review our experience with skin banking of DIEP flaps and determine the cost-benefit of skin banking compared with other reconstructive options. CONCLUSIONS: Skin banking maximizes aesthetic outcomes after skin loss from either positive margins or skin flap necrosis. Use of this technique should occur especially in select patients at increased risk of mastectomy skin flap/nipple-areola complex (NAC) necrosis and/or suspicion for occult NAC carcinoma. Furthermore, among reconstructive plastic surgeons whose rate of mastectomy flap/NAC necrosis >10 cm exceeds 25.3%, sensitive analysis favors undergoing a staged reconstruction after NSM. METHODS: This was a retrospective review study conducted from 2011 to 2014 to examine patients undergoing staged DIEP reconstruction immediately after NSM. Medicare reimbursement costs using Current Procedural Terminology codes, and provider and facilities fees for conventional reconstructions options versus skin banking were obtained with subsequent cost-minimization and sensitivity analyses. RESULTS: The proportion of patients who developed mastectomy skin necrosis was 12.1%, and that of those who had a positive retroareolar biopsy corresponding to an average surface area of 58.3 cm was 3.0%. Average per patient cost of skin banking was
English
0148-7043
10.1097/SAP.0000000000002067 [doi]
*Breast Neoplasms/su [Surgery]
*Mammaplasty/ec [Economics]
*Mastectomy, Subcutaneous/ec [Economics]
*Nipples/su [Surgery]
*Perforator Flap/ec [Economics]
Adult
Breast Neoplasms/ec [Economics]
Esthetics
Female
Humans
Mammaplasty/mt [Methods]
Mastectomy, Subcutaneous/mt [Methods]
Middle Aged
Patient Satisfaction
Perforator Flap/su [Surgery]
Retrospective Studies
United States
MedStar Washington Hospital Center
Surgery
Journal Article
BACKGROUND: Skin necrosis after nipple-sparing mastectomy (NSM) and deep inferior epigastric perforator (DIEP) breast reconstruction impacts cosmesis and patient satisfaction. Skin grafting might mitigate these sequelae, but oftentimes creates a color and texture mismatch with native breast skin. In contrast, abdominal skin on the DIEP flap is an excellent match and can be banked. The purposes of this study are to review our experience with skin banking of DIEP flaps and determine the cost-benefit of skin banking compared with other reconstructive options. CONCLUSIONS: Skin banking maximizes aesthetic outcomes after skin loss from either positive margins or skin flap necrosis. Use of this technique should occur especially in select patients at increased risk of mastectomy skin flap/nipple-areola complex (NAC) necrosis and/or suspicion for occult NAC carcinoma. Furthermore, among reconstructive plastic surgeons whose rate of mastectomy flap/NAC necrosis >10 cm exceeds 25.3%, sensitive analysis favors undergoing a staged reconstruction after NSM. METHODS: This was a retrospective review study conducted from 2011 to 2014 to examine patients undergoing staged DIEP reconstruction immediately after NSM. Medicare reimbursement costs using Current Procedural Terminology codes, and provider and facilities fees for conventional reconstructions options versus skin banking were obtained with subsequent cost-minimization and sensitivity analyses. RESULTS: The proportion of patients who developed mastectomy skin necrosis was 12.1%, and that of those who had a positive retroareolar biopsy corresponding to an average surface area of 58.3 cm was 3.0%. Average per patient cost of skin banking was
English
0148-7043
10.1097/SAP.0000000000002067 [doi]
*Breast Neoplasms/su [Surgery]
*Mammaplasty/ec [Economics]
*Mastectomy, Subcutaneous/ec [Economics]
*Nipples/su [Surgery]
*Perforator Flap/ec [Economics]
Adult
Breast Neoplasms/ec [Economics]
Esthetics
Female
Humans
Mammaplasty/mt [Methods]
Mastectomy, Subcutaneous/mt [Methods]
Middle Aged
Patient Satisfaction
Perforator Flap/su [Surgery]
Retrospective Studies
United States
MedStar Washington Hospital Center
Surgery
Journal Article