Extended latissimus dorsi rotational V-Y advancement flap for the reconstruction of axillary defects after excision of hidradenitis suppurativa.

procedure. Ninety female patients had free flap breast reconstruction at the University of California, Irvine from January of 2004 to December of 2008. The average reimbursement was 38.3 percent of billed charges. The mean and median reimbursement was $6597 and $4962, respectively. Of these 90 patients, seven returned to the group for a cosmetic procedure, for a total of nine procedures. One of these patients had multiple cosmetic procedures. The overall return rate of subjects for cosmetic procedures after microvascular free flap breast reconstruction is 7.7 percent. In addition, the incidence of cosmetic surgery after microvascular free flap breast reconstruction was one cosmetic surgical procedure for every 10 microvascular free flap breast reconstructions performed, or close to two procedures per year. Although there is an 8 percent self-referral rate for cosmetic procedures, the total number of cosmetic referrals is expected to be larger because these data are inclusive of only the subject specifically and do not account for patient referrals, family members, fillers, or neuromodulators. If each free flap breast reconstruction performed can yield an additional cosmetic procedure rate of 10 percent, with an assumption that a cosmetic procedure costs on average $3992.36 (based on the American Society for Aesthetic Plastic Surgery list of cost per surgical procedure),2 each free flap procedure will earn an additional $400 in cosmetic revenue. This would total $6996 for each free flap performed but does not count the extra time spent in performing the cosmetic procedure. Although the trend of declining reimbursement continues, plastic surgeons who perform free flap breast reconstruction can expect to build their cosmetic practice with $400 of additional revenue by satisfying their free flap breast reconstruction patients (Table 1). DOI: 10.1097/PRS.0b013e3182419b5a