Bilateral mastectomy operations and the role for the cosurgeon technique: A Nationwide analysis of surgical practice patterns

Abstract

Traditionally, bilateral mastectomy (BM) operations are performed by a single surgeon but a two‐attending co‐surgeon technique (CST) has been described. A questionnaire was sent to members of the American Society of Breast Surgeons to assess national BM practices and analyze utilization and perceived benefits of the CST. Among surgeons responding, most continue to use the single‐surgeon approach for BMs; however, 14.1% utilize the CST and up to 31% are interested in future CST use. Time savings, mentorship, cost savings, and opportunity to learn new techniques were identified as perceived CST advantages.

The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis

“…The co-surgeon approach, besides allowing for mentorship, is a good opportunity to learn new techniques, tips, and tricks to improve perioperative outcomes in a bi-directional way. 12 For instance, it can reduce or prevent fatigue when performing long surgical procedures and reduce the risk of error, an indicator of difficult assessment. 27 , 51 , 53 Although the co-surgeon model is both operator and procedure dependent, a judicious assessment of the surgical skills and personal reflection can guide the decision to incorporate a second set of hands from another colleague.…”

“…1 Another strategy to optimize perioperative outcomes can be the incorporation of a co-surgeon. 10–15 With this modality, critical steps of complex microsurgical reconstructive procedures can occur concurrently rather than in sequence. 1…”

“…[10][11][12][13][14][15] With this modality, critical steps of complex microsurgical reconstructive procedures can occur concurrently rather than in sequence. 1 Reduced operative time, shorter length of stay, and lesser healthcare-associated costs have been reported with a co-surgeon model for the ablative segment of breast oncologic procedures (mastectomy), [10][11][12] whereas reduced estimated blood loss, 14,15 complication rates, 14 requirements of narcotics, 15 operative time, and improved operating room utilization costs have been reported in the field of orthopedic and neurological surgery with a co-surgeon. [13][14][15] The purpose of this review was to evaluate the role of a co-surgeon model for microvascular breast reconstruction (MBR) in plastic surgery.…”

Outcomes of single vs double surgeon for bilateral mastectomies

“…Bilateral mastectomies are unique as they allow an opportunity for a cosurgeon to perform a simultaneous procedure on the contralateral side as opposed to assisting the primary surgeon. While most surgeons continue to operate independently, 14.1% utilize a second surgeon for bilateral mastectomy cases and 31% are interested in using one in the future, citing improvements in time and cost as well as opportunities for mentorship and learning new techniques that are available in two‐surgeon situations . Two attending surgeons have been shown to reduce operative time by almost a third when performing bilateral mastectomies without affecting complication rates when compared to single‐surgeon bilateral cases .…”

“…Interest remains in the two‐surgeon technique nationwide despite its limited implementation in hopes of improving time and cost without sacrificing quality. As cited in other work of this journal, two‐surgeon operations also give an opportunity for mentorship as well as a chance to teach new techniques to trainees and learn new skills as attendings . As fellowship training programs expand, integrating teaching and operative independence into surgery without compromising time or patient outcomes is increasingly significant.…”