Autologous Breast Reconstruction Versus Implant-Based Reconstruction

How Do Long-Term Costs and Health Care Use Compare?

Valerie Lemaine, M.D., M.P.H.; Stephanie R. Schilz, B.A.; Holly K. Van Houten, B.A.; Lin Zhu, M.D.; Elizabeth B. Habermann, Ph.D.; Judy C. Boughey, M.D.


Plast Reconstr Surg. 2020;145(2):303-311. 

In This Article


Health care reimbursement models are transitioning from volume-based to value-based models. Value-based health care measures health outcomes against the cost of delivering these outcomes. Assessing value of breast reconstruction approaches poses a unique challenge because of the inherent variability in breast reconstruction techniques that influences how we will define what constitutes an episode of care. Our analysis of a large series of women undergoing immediate breast reconstruction found that although index and subsequent costs varied between implant-based and autologous breast reconstruction, the total 2-year costs were similar. As the widespread adoption of a bundled care model is being considered in the United States to improve value of care, further research that incorporates comorbidities, outcomes data, health care use, and cost is needed to inform policy decisions in plastic surgery. Overall, our data provide an important addition to the literature as patients and their plastic surgeon often confront a difficult decision in choosing between breast reconstruction procedures.