Abstract:
BACKGROUND:The financial reimbursement for breast reconstruction is perceived to be low. The authors evaluated the financial impact of providing breast reconstruction for an academic medical practice and health care system. METHODS:The authors examined the billing records for 97 patients undergoing postmastectomy breast reconstruction in 2006 at the University of Michigan. Professional net revenue was calculated by applying actual collection rates to procedural charges. Facility revenue was calculated by applying actual collection rates to charges from inpatient care and the operating room. RESULTS:The payer mix was 70.1 percent private insurance, 22.7 percent health maintenance organization, 3.1 percent Medicare, 2.1 percent Medicaid, and 2.0 percent uninsured. The professional revenue and costs allocated to breast reconstruction were $242,078 and $177,411, respectively [net profit of $64,667 (27 percent)]. Health system facility revenue and costs were $1,109,678 and $943,892, respectively [net profit of $165,786 (15 percent)]. Physician reimbursement by surgical time was highest for delayed tissue expander placement ($1977.70/hour in the operating room) and lowest for immediate transverse rectus abdominis myocutaneous (TRAM) flaps ($327/hour in the operating room). The facility received the greatest average direct margin on TRAM flaps ($3471) and lost money on latissimus dorsi flaps (-$398 margin). CONCLUSIONS:Postmastectomy breast reconstruction at this academic medical center is fiscally advantageous for both the surgical department and the health care system. However, reimbursement varies dramatically by type and timing of reconstructive procedure. Although immediate postmastectomy reconstructions with TRAM flaps provide superior aesthetic results with the greatest amount of patient satisfaction, poor physician reimbursement for these labor-intensive procedures may limit the ability of surgeons to provide these services because of poor financial return.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Alderman AK,Storey AF,Nair NS,Chung KCdoi
10.1097/PRS.0b013e3181a0722dsubject
Has Abstractpub_date
2009-05-01 00:00:00pages
1408-1413issue
5eissn
0032-1052issn
1529-4242pii
00006534-200905000-00002journal_volume
123pub_type
杂志文章abstract::Forty-two patients operated on by skin expansion have been contacted after a mean time of 25 months from the last surgery. Two biopsies have been taken from the expanded area of each patient. In 12 patients it has been possible to obtain a similar sampling from the opposite, nonexpanded area of the body. The samples u...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199210000-00013
更新日期:1992-10-01 00:00:00
abstract:BACKGROUND:Patients with Apert, Crouzon, and Pfeiffer syndromes who have severe midfacial hypoplasia are treated by Le Fort III midface advancement. The purpose of this study was to examine long-term (10-year) midface skeletal stability and growth following Le Fort III midface advancement in growing children. METHODS:...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181e60502
更新日期:2010-09-01 00:00:00
abstract::The nasolabial and labiomandibular folds develop with facial aging by an anterior caudal descent of the fat prominences of the same name. Young patients with minimal folding can be corrected by substances inserted in the fold; however, this and other techniques have failed satisfactorily to improve the folds naturally...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199109000-00009
更新日期:1991-09-01 00:00:00
abstract:BACKGROUND:Recent studies have demonstrated low levels of National Institutes of Health funding for surgical research. The authors compared the funding in plastic surgery with the funding for other surgical specialties. METHODS:A query of National Institutes of Health grants awarded to departments of surgical specialt...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000003866
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:In 2002, the author implemented a new two-stage approach, "delayed-immediate breast reconstruction," for patients who desire breast reconstruction and who are at an increased risk for conditions necessitating postmastectomy radiotherapy. There is increasing acceptance of this approach in clinical practice. T...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181c82d58
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Autologous fat transplantation (or lipofilling) is an excellent technique for correction of cosmetic defects. The success of the procedure relies strongly on the techniques of harvesting and transferring viable adipocytes. The purpose of this study was to evaluate effects of two harvesting methods and coenzy...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000258395.81926.d8
更新日期:2007-04-01 00:00:00
abstract::Cigarette smoke, and specifically nicotine, has been shown to reduce skin-flap survival. The purpose of this study was to determine if the preoperative administration of pentoxifylline can counteract the deleterious effects of nicotine on skin-flap survival in the rat. Sixty rats were distributed into four groups (n =...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199707000-00011
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Harvesting of rib as a source of cartilage can result in significant donor-site morbidity. In experienced hands, excellent results from using autologous rib cartilage are achievable for ear reconstruction, rhinoplasty, and otolaryngology. The authors report the morbidity associated with the harvest of costal...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e318170709e
更新日期:2008-06-01 00:00:00
abstract:LEARNING OBJECTIVES:After studying this article, the participant should be able to: 1. Describe the goals of nasal reconstruction as they apply to extensive, complex defects that may also involve the adjacent lip or cheeks. 2. Understand the advantages and disadvantages of different options for reconstruction of lining...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000298113.56554.c3
更新日期:2008-02-01 00:00:00
abstract::We present a patient who sustained bilateral below-knee amputations that were treated with skin grafts as initial coverage. A latissimus dorsi free flap was later used as definitive coverage of one stump. Then at a subsequent operation a portion of the same latissimus dorsi free flap was reharvested, again as a free f...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198907000-00025
更新日期:1989-07-01 00:00:00
abstract:SUMMARY:Exposure to air pollutants has been now associated with detrimental effects on a variety of organs, including the heart, lungs, GI tract, and brain. However, recently it has become clear that pollutant exposure can also promote the development/exacerbation of a variety of skin conditions, including premature ag...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000007617
更新日期:2021-01-01 00:00:00
abstract::A tape and applicator designed to give preoperative blepharoplasty patients an idea of the proposed result has been developed. The use of the tape as a cosmetic device to temporarily give the effect of a surgical blepharoplasty is presented. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198511000-00024
更新日期:1985-11-01 00:00:00
abstract::The anomaly of facial cleft no. 1 has been encountered recently. It is a rare finding and, accordingly, is being reported with the hope that more craniofacial clefts will be seen in the future and direct the attention of the medical community to the problems. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199412000-00022
更新日期:1994-12-01 00:00:00
abstract::The subperiosteal endoscopic laser forehead lift is shown to be an effective tool for plastic surgeons. By combining the use of the carbon dioxide laser with the already established technique of endoscopic forehead lift, improved results are achieved. The technique of endoscopic forehead lifting lends itself to new ad...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199808000-00034
更新日期:1998-08-01 00:00:00
abstract::The coverage of defects of the Achilles tendon, malleoli, and heel remains a challenge to reconstructive surgeons. The distally based superficial sural artery island flap is vascularized by the median superficial sural artery, posterolateral septal perforators originating from the peroneal artery, neurovascular arteri...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199812000-00013
更新日期:1998-12-01 00:00:00
abstract::A study of the source of the blood supply to the anterolateral femoral flap was carried out on 42 lower limbs of adult cadavers (among them 35 cadavers with injection of red latex and 1 with india ink into the arteries and 6 vascular cast specimens), and the surface locations of the vascular pedicle were detected on 5...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1988-08-01 00:00:00
abstract::Logical correction of aging contour changes of the face is based on understanding its structure and the processes involved in the aging appearance. Aging changes are seen at all tissue levels between the skin and bone although the relative contribution of each component to the overall change of facial appearance has y...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0000000000001752
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND:Surgical flaps have become safe and reliable reconstructive tools, but total flap loss rates as high as 25 percent and partial flap loss rates as high as 36 percent have been reported due to insufficient perfusion. Therefore, a reliable, noninvasive, and effective way to improve the microcirculation of surgi...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000002664
更新日期:2016-11-01 00:00:00
abstract::Cartilage structures from the head and neck possess a certain but limited capacity to heal after injury. This capacity is accredited to the perichondrium. In this study, the role of the inner (cambium) and the outer (fibrous) layers of the perichondrium in cartilage wound healing in vitro is investigated. For the firs...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.PRS.0000020991.10201.6C
更新日期:2002-09-15 00:00:00
abstract:BACKGROUND:There is an increased push for plastic surgery units in the United States to become independent departments administered autonomously rather than as divisions of a multispecialty surgery department. The purpose of this research was to determine whether there are any quantifiable differences in the academic p...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000003772
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Although much has been published with regard to the columella assessed on the frontal and lateral views, a paucity of literature exists regarding the basal view of the columella. The objective of this study was to evaluate the spectrum of columella deformities and devise a working classification system based...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000000022
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Upper airway narrowing has been a concern of mandibular setback. The aims of this study were (1) to evaluate the effect of bimaxillary rotational setback surgery on upper airway structure in patients with skeletal class III deformities, and (2) to compare the preoperative and postoperative upper airways of c...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000000913
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Restoration of biomechanical strength following surgical reconstruction of tendon or ligament insertion tears is challenging because these injuries typically heal as fibrous scars. The authors hypothesize that injuries at the tendon-bone interface would benefit from reconstruction with decellularized composi...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000436823.64827.a0
更新日期:2014-01-01 00:00:00
abstract:LEARNING OBJECTIVES:After reading this article and watching the accompanying videos, the participant should be able to: 1. Assess patients seeking facial volumization and correlate volume deficiencies anatomically. 2. Identify appropriate fillers based on rheologic properties and anatomical needs. 3. Recognize poor can...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000002238
更新日期:2016-05-01 00:00:00
abstract::Subfascial placement of implants was introduced 3 years ago. Collected data reveal very promising short-term and long-term results in comparison with subglandular and subpectoral positioned implants. The clinical experiences of 69 breast augmentations in the subfascial position are reported. The indications for this t...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000135906.48388.22
更新日期:2004-10-01 00:00:00
abstract::Successful reconstructive surgery with muscle flaps depends on adequate arterial supply and undisturbed venous drainage. Combining such surgery with reconstructive vascular surgery of a large-caliber vein that is responsible for the venous drainage of the flap poses an additional challenge--the repaired vein's suscept...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200102000-00032
更新日期:2001-02-01 00:00:00
abstract::Treatment options for the craniosynostoses vary from conservative observation until completion of growth to radical remodeling in infancy. To further define the timing and type of treatment necessary in these complex disorders, we have retrospectively analyzed all patients operated on for this deformity during the pas...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1987-08-01 00:00:00
abstract::Preexpansion scoring releases the inflexible galea, permitting more rapid expansion of the scalp. In addition, when comparing this procedure with conventional scalp expansion, patients reported less pain when the galea was incised prior to insertion of the tissue expanders. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199404001-00032
更新日期:1994-04-01 00:00:00
abstract:BACKGROUND:The ideal face lift has the longest efficacy, the fewest complications, and ultimately, the highest patient satisfaction. With so many different techniques, there exists a need to make this comparison and to establish which approaches may work best in various groups. To date, there has been no systematic rev...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0b013e3181f95c08
更新日期:2011-01-01 00:00:00
abstract::This paper reports 11 cases of recurrence 10 years or more after primary treatment of clinically local cutaneous melanoma at the Peter MacCallum Cancer Institute. Using the product-limit method for estimating recurrence-free survival, two late recurrence rates have been calculated. The estimated late recurrence rate a...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199009000-00024
更新日期:1990-09-01 00:00:00