Outcomes and Economic Evaluation in Delayed Two-Stage Breast Reconstruction in Romania: The Influence of Radiotherapy

SIMPLE SUMMARY: Following radical mastectomy in breast cancer, the trend nowadays is toward immediate breast reconstruction due to the improvement in diagnostic tools. Around 30% of the patients suffering from breast cancer will need modified radical mastectomy, and some will need postmastectomy radiotherapy (PMRT). In the presence of PMRT, the reconstructive possibilities become a subject of debate because of the increased risk of reconstructive complications. The cost of reconstruction treatment of the breast in Romania is calculated based on the diagnosis-related group, which considers the patient’s comorbidities, the type of surgical procedure, and the length of hospitalization. The main aim of this paper is to review the effects of radiotherapy on the outcome and the costs of delayed two-stage breast reconstruction in a representative cohort of patients in Bucharest, Romania. ABSTRACT: The current paper is a retrospective cohort study conducted on sixty-seven patients who underwent two-stage breast reconstruction over a 5-year period (2015–2020). Forty-one (61.2%) patients received radiotherapy (RT group), and twenty-six (38.8%) did not (non-RT group). Data regarding patients, oncological therapies, type of reconstruction, time of hospitalization, complications, and costs were collected. The statistical analysis was performed using IBM SPSS Statistics 25. General complications were noted for 18 patients (43.9%) in the RT group and for 7 patients (26.9%) in the non-RT group. Major complications were observed only in the first group (five patients–12.2%). The mean time of hospitalization in the RT group was 14.83 days for patients with complications versus 9.83 days for those without complications and 15.5 days versus 8.63 days, respectively, in the non-RT group. The mean cost for patients without complications was 235.64 euros, whereas the cost for patients with complications was 330.24 euros (p = 0.001). Radiation therapy can affect the overall outcome by increasing the risk of complications and increasing costs; however, our paper shows that the association of alloplastic reconstruction in patients with radiotherapy can be performed safely and with low costs in carefully selected patients.