Bilateral mastectomies: can a co-surgeon technique offer improvements over the single-surgeon method?

Abstract

Purpose

Bilateral mastectomy (BM) is traditionally performed using a single-surgeon (SS) technique (SST); a co-surgeon (CS) technique (CST), where each attending surgeon concurrently performs a unilateral mastectomy, offers an alternative approach. We sought to compare the CST and SST for BM with respect to operative times and complications.

Methods

Patients undergoing BM without reconstruction at our institution between 2005 and 2015 were identified using operative caselogs and stratified into CS- and SS-cohorts. Operative time (OT; incision to closure) was calculated. Patient age, cancer presence/stage, hormone receptor/BRCA status, breast weight, axillary procedure, and 30-day complications were extracted. Differences in OT, complications, and demographics between cohorts were assessed with t tests and Chi-square tests. A multivariate linear regression model was fit to identify factors independently associated with OT.

Results

Overall, 109 BM cases were identified (CS, n = 58 [53.2%]; SS, n = 51 [46.8%]). Average duration was significantly shorter for the CST by 33 min (21.6% reduction; CS: 120 min vs. SS: 153 min, p < 0.001), with no difference in complication rates (p = 0.65). Demographic characteristics did not differ between cohorts except for total breast weight (TBW) (CS: 1878 g vs. SS: 1452 g, p < 0.05). Adjusting for TBW, CST resulted in a 27.8% reduction in OT (44-min savings, p < 0.001) compared to SST.

Conclusions

The CST significantly reduces OT for BM procedures compared to the SST without increasing complication rates. While time-savings was < 50% and may not be ideal for every patient, the CST offers an alternative BM approach potentially best-suited for large TBW patients and those undergoing axillary procedures.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to acknowledge the following individuals who contributed to making this work possible: Kristen Camuso, Fred Syllien, Kaitlyn Bifolck, Katya Losk, Linda Cutone, Ingrid Stendhal, Lawanda Dixon, Ritam Chowdhury, and William Davis.

Funding

This study was funded in part by the National Institute of Health Grant R25 CA089017 and the Breast Cancer Research Foundation.

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Correspondence to Mehra Golshan.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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The content is solely the responsibility of the authors and does not necessarily represent the official views of Brigham and Women’s Hospital or the National Institutes of Health.

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Mallory, M.A., Tarabanis, C., Schneider, E. et al. Bilateral mastectomies: can a co-surgeon technique offer improvements over the single-surgeon method?. Breast Cancer Res Treat 170, 641–646 (2018). https://doi.org/10.1007/s10549-018-4794-y

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Keywords

  • Breast surgery
  • Bilateral mastectomy
  • Breast reconstruction
  • Co-surgeon
  • Operative time