Does “Two is Better Than One” Apply to Surgeons? Comparing Single-Surgeon Versus Co-surgeon Bilateral Mastectomies

Abstract

Background Bilateral mastectomies (BM) are traditionally performed by single surgeons (SS); a co-surgeon (CS) technique, where each surgeon concurrently performs a unilateral mastectomy, offers an alternative approach. We examined differences in general surgery time (GST), overall surgery time (OST), and patient complications for BM performed by CS and SS. Methods Patients undergoing BM with tissue expander reconstruction (BMTR) between January 2010 and May 2014 at our center were identified through operative case logs. GST (incision to end of BM procedure), reconstruction duration (RST) (plastic surgery start to end of reconstruction) and OST (OST= GST + RST) was calculated. Patient age, presence/stage of cancer, breast weight, axillary-procedure performed, and 30-day postoperative complications were extracted from medical records. Differences in GST and OST between CS- and SS-cases were assessed with a t-test. A multivariate linear regression was fit to identify factors associated with GST. Results 116 BMTR cases were performed [CS, n=67 (57.8%); SS, n=49 (42.2%)]. Demographic characteristics did not differ between groups. GST and OST were significantly shorter for CS-cases, 75.8 vs. 116.8 minutes, p<0.0001, and 255.2 vs. 278.3 minutes, p=0.005, respectively. Presence of a CS significantly reduces BMTR time (β=−38.82, p<0.0001). Breast weight (β=0.0093, p=0.03) and axillary dissection (β=28.69, p=0.0003) also impacted GST. Conclusions The co-surgeon approach to BMTR reduced both GST and OST, however the degree of time-savings (35.1% and 8.3% respectively) was less than hypothesized. A larger study is warranted to better characterize time, cost, and outcomes of the CS-approach for BM.

An analysis of free flap failure using the ACS NSQIP database. Does flap site and flap type matter?

“…Thus special attention should be made to decrease operative times specifically for patients undergoing free flap based breast reconstruction. Possible ways to decrease operative time may include using two operative teams or staging procedures (Gosseringer, Mani, Cali‐Cassi, Papadopouloua, Rodriguez‐Lorenzo, in press; Mallory, Losk, Camuso, Caterson, Numbkar, Golshan, ; Sullivan, Fletcher, Isom, Isik, ).…”

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

“…A recent NSQIP analysis suggested prolonged OT is an independent risk factor for free‐flap failure, advocating consideration of a CST to reduce OT . Flap differences due to variability in surgical technique could, however, potentially increase reconstruction time . While approximately half of our respondents' BMs (52.2%) involved immediate reconstruction, we did not query whether planned reconstruction impacted CST use.…”

“…16 Flap differences due to variability in surgical technique could, however, potentially increase reconstruction time. 5 While approximately half of our respondents' BMs (52.2%) involved immediate reconstruction, we did not query whether planned reconstruction impacted CST use. Further research regarding CST impact on reconstructive efforts would be useful to better inform implementation efforts.…”

“…Bilateral mastectomy (BM) operation rates have been increasing despite evidence establishing equivalent survival outcomes between breast‐conserving surgeries and mastectomies . The BM operation is traditionally performed by a single attending surgeon (single‐surgeon technique, SST); however, we recently described a “co‐surgeon” technique (CST) in which two breast surgeons each complete one side of the bilateral procedure simultaneously . This approach has the capability of reducing operative times (OT) without increasing complications.…”

“…[1][2][3][4] The BM operation is traditionally performed by a single attending surgeon (single-surgeon technique, SST); however, we recently described a "co-surgeon" technique (CST) in which two breast surgeons each complete one side of the bilateral procedure simultaneously. 5,6 This approach has the capability of reducing operative times (OT) without increasing complications.Here, we assess current nationwide practice patterns of surgeons performing BMs focusing on the utilization and interest in the CST.…”