The Impact of Breast Reduction Practice Variation in Hamilton, Ontario: A Cost Analysis

<b>Introduction:</b> Bilateral breast reduction (BBR) is one of the most common Ministry of Health-funded plastic surgery procedures. Surgeon variation in BBR management has been reported. In this study, we aimed to answer the following: what are the current variations in plastic surgeons' management of BBR in Hamilton, Ontario?, and what are the cost implications of these practice variations to the healthcare system and patients? <b>Methods:</b> An online survey was conducted to gather demographic and practice data from all plastic surgeons practicing in Hamilton from 2019 to 2024. Reference costs for pre-, intra-, and postoperative components of BBR were obtained from a tertiary academic care center, the Ontario Schedule of Benefits for Physician Services, and local nursing care agencies, and used in the calculation of individual surgeons' healthcare and patient costs. <b>Results:</b> Among 17 plastic surgeons practicing in Hamilton, 9 perform BBR, and 7 participated in the survey (response rate = 77.8%). Variations in practice were identified across several areas, including drain use, nursing care, OR time, and frequency of physician appointments. The mean healthcare costs per BBR patient were $5156 and $7146 for the lowest- and highest-costing surgeons, respectively, resulting in a difference of up to $2034 per patient. Patient-borne costs varied from $92 to $179 between surgical practices. <b>Conclusion:</b> There is considerable variability in BBR practice among plastic surgeons in Hamilton, contributing to a difference in overall healthcare and patient costs. Given the importance of cost savings in a single-payer system, future research is warranted to standardize BBR practices.