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

• Published in: Breast cancer research and treatment Vol. 170; no. 3; pp. 641 - 646
• Main Authors: Mallory, Melissa Anne, Tarabanis, Constantine, Schneider, Eric, Nimbkar, Suniti, Golshan, Mehra
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2018; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - epidemiology; Breast Neoplasms - surgery; Cancer; Cancer research; Demographics; Demography; Epidemiology; Female; Humans; Mammaplasty - adverse effects; Mammaplasty - methods; Mastectomy; Mastectomy - adverse effects; Mastectomy - methods; Medicine; Medicine & Public Health; Methods; Middle Aged; Neoplasm Staging; Oncology; Operative Time; Outcome Assessment (Health Care); Postoperative Complications; Retrospective Studies; Surgeons; Surgery; Co-surgeon; Operative time; Bilateral mastectomy; Breast reconstruction; Breast surgery
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-018-4794-y

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.