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Two-stage expander/implant breast reconstruction versus prepectoral breast reconstruction with acellular dermal matrix: a cost analysis

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The aim of this retrospective study is to analyze and compare the cost of two-step breast reconstruction with expander/implant versus total prepectoral breast reconstruction (BR) with acellular dermal matrix (ADM). Patients’ satisfaction was also evaluated.


A retrospective investigation was performed on the patients who underwent breast reconstruction between December 2017 and October 2019 by Plastic and Reconstructive Microsurgery at Careggi University Hospital in Florence and divided into group A (prepectoral BR with breast implants and ADM) and group B (BR with breast expander and implant). Complications, patients’ satisfaction with BREAST-Q questionnaire, and complete cost analysis for each type of reconstruction have been analyzed and compared.


Seventy-two patients were recruited for the study, divided into group A (32 patients) and group B (40 patients). The total number of complications is 8 cases out of 36 (22.22%) in the group of cases and 10 out of 42 (23.80%). For patients’ satisfaction, the statistical analysis does not show significant differences both with a parametric and with non-parametric tests. Total overall cost of expander/prosthesis with BR is 7308.83 €, while the cost of immediate prepectoral reconstruction is around 8062.76 € showing an increase in expenditure compared to the control group of 753.93 €. This difference corresponds to 9.35% of the price of prepectoral BR.


Our results showed no major differences among the two techniques. The minor difference in costs for prepectoral technique is justified with main advantages of a reduce number of hospitalizations and, consequently, waiting list for breast reconstruction.

Level of evidence: Not gradable.

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Correspondence to Alessandro Innocenti.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. For this retrospective study no formal consent is required.

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Informed consent was obtained from all patients for being included in the study. Additional consent was obtained to share their photographs.

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Innocenti, A., Melita, D. Two-stage expander/implant breast reconstruction versus prepectoral breast reconstruction with acellular dermal matrix: a cost analysis. Eur J Plast Surg 45, 601–615 (2022).

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