Mastectomy plus reconstruction equals rise in complication rates, costs

The 140,000 U.S. women diagnosed each year with early-stage breast cancer, when the tumor is still small and hasn’t spread, have a variety of treatment options. All offer similar survival rates when initiated in the early stages of the disease.

Yet in increasing numbers, women are choosing the most aggressive option — mastectomy followed by breast reconstruction.

A recent MD Anderson study suggests women may want to reconsider before undergoing such an extensive and expensive procedure.

The study found that mastectomy, when combined with breast reconstruction, carries a high risk of complications and a heavy financial cost resulting from those complications.

Researchers analyzed 10 years of medical claims data from more than 100,000 women with early-stage breast cancer. They divided study subjects into two groups — one group include women age 65 and younger who had private health insurance, and a second group consisted of Medicare enrollees older than 65.

The findings were surprising, says Benjamin Smith, M.D., associate professor of Radiation Oncology at MD Anderson and the study’s lead author.

More than half of younger patients who had a mastectomy plus reconstruction experienced complications, such as infection. For women age 65 and older who received the procedure, the complication rate was nearly 70 percent.

Lumpectomy, a procedure where the tumor is removed and the breast is spared, followed by radiation, had a complication rate ranging from about 30 to 45 percent among younger women.

“What we show for the first time is that patients who undergo more surgery are also taking on considerably more risk with regard to what could happen. If the patient can have a lumpectomy and radiation, it may be a smoother course than going through a mastectomy, reconstruction and potentially other surgeries,” explained Smith.

The study also analyzed the financial burden of complications. Smith and colleagues found that the cost of caring for complications resulting from mastectomy and reconstruction averaged $10,005. The costs for complications after lumpectomy and whole-breast irradiation averaged far less, at $1,397.

Smith believes this type of data will provide guidance for insurance companies as they start to think about bundled payments for breast cancer care.

Despite the findings, Smith stresses that for some patients with early breast cancer, mastectomy plus reconstruction is truly their best treatment option, and that these research findings shouldn't be used to decrease reimbursement or coverage when this procedure is medically indicated.

Read more about this study on MD Anderson’s website.