With improvement in mastectomy skin flap viability and increasing recognition of animation deformity following sub-pectoral implant placement, there has been a transition toward pre-pectoral breast reconstruction. While studies have explored the cost effectiveness of implant-based breast reconstruction, few investigations have evaluated cost with respect to pre-pectoral versus sub-pectoral breast reconstruction. A retrospective review of 548 patients who underwent mastectomy and implant-based breast reconstruction was performed from 2017 to 2020. The demographic and surgical characteristics of the pre-pectoral and sub-pectoral cohorts were well matched, except for reconstructive staging, as patients who underwent pre-pectoral reconstruction were more likely to undergo single-stage instead of two-stage reconstruction. Comparison of institutional cost ratios by reconstructive technique revealed that the sub-pectoral approach was more costly (1.70 ± 0.44 vs 1.58 ± 0.31, p < 0.01). However, further stratification by laterality and reconstructive staging failed to demonstrate difference in cost by reconstructive technique. These results were confirmed by multivariable linear regression, which did not reveal reconstructive technique to be an independent variable for cost. This study suggests that pre-pectoral breast reconstruction is a cost-effective alternative to sub-pectoral breast reconstruction and may confer cost benefit, as it is more strongly associated with direct-to-implant breast reconstruction.

No abstract

METHODS:A retrospective review was performed of patients under 18 years of age who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, etiology, medical history, associated injuries, treatments, and outcomes. RESULTS: 532 pediatric patients (141 female, 391 male) with a total of 1005 mandibular fractures were included; more than half of the patients (56.77%, n = 302) were transferred. Out of 302 total transfers, 178 (58.9%) were inappropriate. Subsequent treatment (conservative vs. surgical) did not differ significantly between transfer and non-transfer groups (p=0.72). Patients who were uninsured (p=0.038) or had concomitant soft tissue injury (p=0.019) were more likely to be transferred. Trauma level, cause of injury, gender, and presence of concomitant fracture, musculoskeletal or brain injury did not significantly influence rate of transfer. CONCLUSION:Uninsured pediatric mandibular fracture patients were more likely to be transferred than their insured peers regardless of presenting trauma level. There was no difference in the rate of surgical management between transferred vs. non-transferred patients. Concurrent softtissue injuries were a significant factor influencing "inappropriate" transfers. Research and innovation in remote plastic surgery consultations for pediatric patients who may not benefit from urgent transfer is needed.