TY - JOUR
T1 - Can the cost affect the choice of various methods of postmastectomy breast reconstruction?
AU - Franchelli, Simonetta
AU - Leone, Maria Stella
AU - Berrino, Pietro
AU - Passarelli, Barbara
AU - Cicchetti, Silvia
AU - Perniciaro, Giuseppe
AU - Delfino, Eliano
AU - Santi, Pierluigi
PY - 1998/5
Y1 - 1998/5
N2 - Aim and background: A wide range of methodologies for breast reconstruction is now available. For immediate breast reconstruction we prefer to use implants, whereas reconstruction using autologous tissues, such as transverse rectus abdominis musculocutaneous flaps (TRAMF) and muscular latissimus dorsi flaps, is applied only in selected cases. In contrast, for delayed reconstruction the choice between prostheses and autologous tissue depends on various conditions. The different reconstructive methods can be adopted as a single procedure or as a combination of surgical procedures. Following the issue of legislation defining the new structure of the Italian Health Service, the need to accurately assess the costs incurred for the execution of surgical operations has taken on paramount importance. The aim of the study was to evaluate not only the clinical limits of each surgical technique, but also its cost, in order to optimize the choice of the same procedures, conditions being equal. Methods: The study population included 105 patients who underwent breast reconstruction in the period 1st January 1994-30th June 1995. The reconstructive procedures included 48 immediate implants, 7 immediate TRAMF, 17 delayed implants, 30 delayed TRAMF, and 3 delayed latissimus dorsi muscular flaps. Results: After data evaluation, we concluded that reconstruction using permanent expandable implants is the most convenient among implant reconstructions for its low global treatment cost. In fact, reconstructive procedures using temporary expanders, which require two surgical operations, have a higher cost than breast reconstruction using permanent expandable implants. Breast reconstruction using TRAMF is the most convenient because it limits the cost of surgical materials and because flap versatility limits the number of modifications on the contralateral breast. In contrast, breast reconstruction using latissimus dorsi flaps has high costs. Conclusions: There is no balance between price list and effective cost of the different surgical reconstructive procedures which may be a point of departure to see whether it is impossible to improve the efficiency of the Health Care System and in any case open a debate between the regions and hospitals to improve the service, keeping it at a good level.
AB - Aim and background: A wide range of methodologies for breast reconstruction is now available. For immediate breast reconstruction we prefer to use implants, whereas reconstruction using autologous tissues, such as transverse rectus abdominis musculocutaneous flaps (TRAMF) and muscular latissimus dorsi flaps, is applied only in selected cases. In contrast, for delayed reconstruction the choice between prostheses and autologous tissue depends on various conditions. The different reconstructive methods can be adopted as a single procedure or as a combination of surgical procedures. Following the issue of legislation defining the new structure of the Italian Health Service, the need to accurately assess the costs incurred for the execution of surgical operations has taken on paramount importance. The aim of the study was to evaluate not only the clinical limits of each surgical technique, but also its cost, in order to optimize the choice of the same procedures, conditions being equal. Methods: The study population included 105 patients who underwent breast reconstruction in the period 1st January 1994-30th June 1995. The reconstructive procedures included 48 immediate implants, 7 immediate TRAMF, 17 delayed implants, 30 delayed TRAMF, and 3 delayed latissimus dorsi muscular flaps. Results: After data evaluation, we concluded that reconstruction using permanent expandable implants is the most convenient among implant reconstructions for its low global treatment cost. In fact, reconstructive procedures using temporary expanders, which require two surgical operations, have a higher cost than breast reconstruction using permanent expandable implants. Breast reconstruction using TRAMF is the most convenient because it limits the cost of surgical materials and because flap versatility limits the number of modifications on the contralateral breast. In contrast, breast reconstruction using latissimus dorsi flaps has high costs. Conclusions: There is no balance between price list and effective cost of the different surgical reconstructive procedures which may be a point of departure to see whether it is impossible to improve the efficiency of the Health Care System and in any case open a debate between the regions and hospitals to improve the service, keeping it at a good level.
KW - Breast reconstruction
KW - Costs
KW - Italian health care structure
KW - Mastectomy
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M3 - Article
C2 - 9678622
AN - SCOPUS:0031837363
VL - 84
SP - 383
EP - 386
JO - Tumori
JF - Tumori
SN - 0300-8916
IS - 3
ER -