Abstract
Objective The purpose of this study was to evaluate the short-term costs, and financial implications
of improvements in operative efficiency of free flap and implant-based breast reconstruction
within an academic practice.
Methods The billing records of 162 patients who underwent postmastectomy implant-based or
free flap breast reconstruction by two newly hired microsurgeons at an academic institution
during the 2011, 2012, and 2013 fiscal years were reviewed. Actual data on professional
revenue, relative value units (RVUs), and facility costs for the first stage of reconstruction
as well as costs of postoperative complications were assessed.
Results Free flaps consistently generated more revenue and RVUs than implants (p < 0.001). Rates of major complications and associated costs were greater for free
flaps during the first 2 years of practice; however, by the 3rd year rates were similar
between free flaps and implants (14.3 vs. 18.2%, p = 0.72). There was a 26% reduction in free flap operative time in 2013 as compared
with 2011. Operative efficiency (hourly RVU) of first stage procedures increased each
year for both modalities. At the completion of reconstruction, flaps and implants
had comparable hourly reimbursement ($1,053 vs. $947, p = 0.72) and hourly RVU (22 vs. 29, p = 0.06).
Conclusions Contrary to perceptions that free flap breast reconstructions are financially inefficient
for the surgeon, we have found that these complex reconstructive procedures are profitable.
Even in the early years of practice, hourly reimbursements from completed flap reconstructions
are similar to reimbursements received from similar staged implant reconstructions.
Keywords
breast reconstruction - free flap reconstruction - efficiency
