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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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

A total of 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 versus 116.8 min, p < .0001, and 255.2 versus 278.3 min, p = .005, respectively. Presence of a CS significantly reduces BMTR time (β = −38.82, p < .0001). Breast weight (β = 0.0093, p = .03) and axillary dissection (β = 28.69, p = .0003) also impacted GST.

Conclusions

The CS 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.

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Acknowledgments

We would like to acknowledge the contributions of Leonard Pettiti and Alexandra Koffman, who assisted us greatly in data extraction, and Dr. Frederick Millham and Robert-Betnick Smith, who provided useful insight and support of this manuscript. This study was funded in part by the National Institute of Health Grant R25 CA089017. 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.

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA

    Melissa Anne Mallory MD, Suniti Nimbkar MD & Mehra Golshan MD

  2. Department of Surgery, Dana-Farber Cancer Institute, Boston, MA, USA

    Melissa Anne Mallory MD & Mehra Golshan MD

  3. Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, MA, USA

    Katya Losk MPH & Kristen Camuso MPH

  4. Division of Plastic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Stephanie Caterson MD

Authors
  1. Melissa Anne Mallory MD
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  2. Katya Losk MPH
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  3. Kristen Camuso MPH
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  4. Stephanie Caterson MD
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  5. Suniti Nimbkar MD
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  6. Mehra Golshan MD
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Corresponding author

Correspondence to Mehra Golshan MD.

Additional information

M.A. Mallory and K. Losk are co-first authors and S. Nimbkar and M. Golshan are co-last authors.

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Mallory, M.A., Losk, K., Camuso, K. et al. Does “Two is Better Than One” Apply to Surgeons? Comparing Single-Surgeon Versus Co-surgeon Bilateral Mastectomies. Ann Surg Oncol 23, 1111–1116 (2016). https://doi.org/10.1245/s10434-015-4956-7

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  • DOI: https://doi.org/10.1245/s10434-015-4956-7

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