The Impact of the Cosurgeon Model on Bilateral Autologous Breast Reconstruction

Abstract

Background Microsurgical breast reconstructions (MBRs) are time and labor intensive procedures. To circumvent these barriers, plastic surgeons have started working together as cosurgeons (CSs). This study aims to evaluate the impact of the CS model (CSM) specifically on bilateral MBR. The hypothesis is that CS procedures reduce operative time and surgical complications. Study Design This was a single institutional retrospective cohort study, which included all consecutive patients who underwent bilateral MBR from 2014 to 2016. Patients were grouped into single surgeon (SS) or CSs based on the number of the attending plastic surgeons present. Demographic and clinical characteristics including age, body mass index, smoking, American Society of Anesthesiologist class, radiation, and the timing of the reconstruction were assessed. Univariate and multivariate analyses were performed for outcomes including operative time and postoperative complications. Results Of the 136 patients included in the study, 41% had breast reconstruction performed by CSs, whereas 59% had a SS. Sociodemographic features were evenly distributed with the exception of a greater number of delayed reconstructions in the SS group (33 vs. 13%; p <0.01). Pedicle TRAMS (transverse rectus abdominis musculocutaneous flaps) were performed in 5 versus 0% of SS versus CS cases, respectively. Rates of major (4 vs. 16%) and minor (11 vs. 24%) complications were significantly lower in CS procedures. Multivariate analyses demonstrated CS operations required significantly shorter operative time by 73 minutes (p <0.001), and trended toward a reduced postoperative complication rate (p = 0.07). Conclusion The CSM is associated with improved operative efficiency for bilateral MBR. Further evaluation of the CSM may prove useful in other surgical disciplines with time and labor intense procedures.

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

“…It is possible that this is related to the relatively small study sizes involved and the infrequency of overall complications associated with these cases, but ultimately, a larger study is warranted to determine the final impact of the CST on patient outcomes. As was noted in a recent study investigating the role of the CST in bilateral microsurgical breast reconstructions, the financial impact of the CST on the healthcare system needs further consideration and further research into these varying financial tradeoffs are required to better understand the potential cost-effectiveness of the CST compared to the traditional SST [11].…”

“…While the CST has been suggested within other surgical subspecialties as a way of effectively reducing operative times and complications and potentially improving outcomes associated with lengthy or complex bilateral procedures, our study was the first to investigate the CST in breast surgery, specifically in cases of BM followed by immediate tissue-expander reconstruction (BMTR) [4–9]. While subsequent research has suggested this approach offers improved operative efficiency for breast reconstruction procedures, further investigation into the role of the CST in reconstruction-free mastectomies has yet to be published [10,11]. Here, we sought to examine the role of the CST in operations in which no immediate reconstruction was performed, to specifically determine if this approach can afford comparable improvements in operative durations without concurrently increasing complication rate, similar to the results observed in the BMTR cohort.…”