Background: Many factors influence a patient's decision to undergo autologous versus implant-based breast reconstruction, including medical, social, and financial considerations. This study aims to investigate differences in out-of-pocket and total spending for patients undergoing autologous and implant-based breast reconstruction. Methods: The IBM MarketScan Commercial Databases were queried to extract all patients who underwent inpatient autologous or implant-based breast reconstruction from 2017 to 2021. Financial variables included gross payments to the provider (facility and/or physician) and out-of-pocket costs (total of coinsurance, deductible, and copayments). Univariate regressions assessed differences between autologous and implant-based reconstruction procedures. Mixed-effects linear regression was used to analyze parametric contributions to total gross and out-of-pocket costs. Results: The sample identified 2079 autologous breast reconstruction and 1475 implant-based breast reconstruction episodes. Median out-of-pocket costs were significantly higher for autologous reconstruction than implant-based reconstruction ($597 vs $250, P < 0.001) as were total payments ($63,667 vs $31,472, P < 0.001). Type of insurance plan and region contributed to variable out-of-pocket costs (P < 0.001). Regression analysis revealed that autologous reconstruction contributes significantly to increasing out-of-pocket costs (B = $597, P = 0.025) and increasing total costs (B = $74,507, P = 0.006). Conclusion: The US national data demonstrate that autologous breast reconstruction has higher out-of-pocket costs and higher gross payments than implant-based reconstruction. More study is needed to determine the extent to which these financial differences affect patient decision-making.

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Introduction: The characteristics, complications, and postoperative analgesic needs of patients with a recent or active history of recreational cannabis use have not been explored explicitly in plastic surgery. In this study, the characteristics, complications, and postoperative analgesic needs within a population of breast reduction patients who use and do not use recreational cannabis were compared. Methods: A retrospective cohort study was carried out on patients who underwent breast reduction between 2019 and 2023. Demographics, comorbidities, recreational cannabis use, postoperative opioid use, and postoperative complications were collected. Patients with a recent history (<1 month since last cannabis use) or current cannabis use were then compared to patients with no history of cannabis use. Results: In total, 340 patients were included, 88 (26%) patients had a history of cannabis use and 252 (74%) did not. Patients in the cannabis-using group were significantly younger than in the non-cannabis-using group (28 years vs 40 years, P < .01), and significantly more patients in the non-cannabis group had hypertension (20% vs 6% P < .01). More patients in the cannabis-using group had hematomas (5% vs 1%, P = .041) and fewer had t-point breakdown (4% vs 0%, P = .046), but these figures lost statistical significance on multiple logistic regression analysis after controlling for possible confounding factors including demographics and comorbidities ( P > .05). There were no significant differences in proportions of opioid use or by doses of opioids, even when converted to oral morphine equivalents ( P > .05). Conclusion: The analgesic needs, postoperative pain levels, and complications between cannabis-using and non-cannabis-using cohorts were similar. Counseling on substance use preoperatively should still be encouraged, especially in younger patients seeking reduction mammaplasty.