J Reconstr Microsurg 2017; 33(09): 624-629
DOI: 10.1055/s-0037-1604106
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Impact of the Cosurgeon Model on Bilateral Autologous Breast Reconstruction

Shantanu N. Razdan*
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Hina J. Panchal*
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Geoffrey E. Hespe
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Joseph J. Disa
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Colleen M. McCarthy
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Robert J. Allen Jr.
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Joseph H. Dayan
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Andrea Pusic
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Babak Mehrara
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Peter G. Cordeiro
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Evan Matros
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
› Author Affiliations
Further Information

Publication History

12 April 2017

24 May 2017

Publication Date:
31 July 2017 (online)

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.

Note

The abstract of this study was presented at the Annual Meeting of American Society for Reconstructive Microsurgery, January 2017, Waikoloa Village, HI.


* Both the authors contributed equally to this study.


 
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