OBJECTIVES : Greater than 85% of UK breast reconstructions are implant based and over 50% include a biologic mesh. This study compared the long-term (five-year) cost of one stage direct to implant Strattice™-assisted and two stage submuscular reconstructions along with aesthetic and patient reported outcomes.

METHODS : Retrospective case note, implant database and theatre log review of consecutive implant based reconstructions performed from January 2009 – December 2011. Clinical coding identified codes and 2017/18 NHS tariffs were used to give a cost per procedure including any revision surgery. Women were invited for clinical, aesthetic and quality of life assessment.

RESULTS : 130 patients underwent 171 immediate IBR. 109 direct to implant Strattice™-assisted (77 patients) and 54 two stage submuscular (47 patients) reconstructions were included.

Total mean cost of the index reconstructive procedure is £3,634 Strattice™-assisted and £4,230 submuscular.

In the Strattice™-assisted group 44 (57%) patients had further planned procedures; 15 contralateral surgeries, 52 nipple reconstructions and 22 removals of Becker™port at a mean cost of £1,026 per reconstruction. In the submuscular group 22 (47%) patients had further planned procedures; 18 contralateral surgeries and 15 nipple reconstructions at a mean cost of £1,016.

Unplanned procedures for either post-operative complications or revision of the reconstruction were performed on 57 (52%) reconstructions in the Strattice™-assisted group and 28 (52%) in the submuscular group at a mean cost of £1,846 and £1,920 respectively.

Mean five-year total cost was £6,506 for the Strattice™-assisted versus £7,166 for the submuscular reconstructions (p=0.2).

The mean aesthetic score was significantly higher in the Strattice™-assisted group. There was no difference in median Breast Q score in any domain between the two groups.

CONCLUSIONS : In this study, we found no significant difference in the long-term financial cost but Strattice™-assisted procedures allow patients to avoid a further planned hospital admission with improved aesthetic outcomes.