title: Two surgeons, one patient: the impact of surgeon-surgeon familiarity on patient outcomes following mastectomy with immediate reconstruction.
abstract: BACKGROUND
  Mastectomy with immediate reconstruction requires the coordination and expertise of two distinct surgeons. This often results in several different combinations of mastectomy and reconstructive surgeons, but with an unknown impact on patient outcomes. We evaluate the effect of different surgical teams on complication rates following mastectomy and immediate reconstruction.
  
  
  METHODS
  Retrospective review of consecutive patients that underwent mastectomy with immediate prosthetic reconstruction from 4/1998 to 10/2008 at one institution was performed. Patients of the three highest-volume mastectomy and reconstructive surgeons were stratified by their individual combination of surgeons, resulting in nine different surgical teams. Complications were categorized by end-outcome. Appropriate statistics, including multiple linear regression, were performed.
  
  
  RESULTS
  Clinical characteristics were similar among patients (n = 511 patients, 699 breasts) with the same mastectomy surgeon but different reconstructive surgeon. Mean follow-up was 38.4 ± 25.7 months. For each mastectomy surgeon, the choice of reconstructive surgeon did not affect complication rates. Furthermore, the combined complication rates of the three highest-volume teams (n = 384 breasts) were similar to the remaining lower-volume teams (n = 315 breasts). Patient factors, but not the individual surgeon or surgical team, were independent risk factors for complications.
  
  
  CONCLUSIONS
  Our study suggests that among high-volume surgeons, complication rates following mastectomy with immediate reconstruction are not affected by the surgeon-surgeon familiarity. The individual surgeon's expertise, and patient risk factors, may have a greater impact on outcomes than the team's experience with each other. These results validate the efficacy and safety of the surgeon distribution model currently used by many breast surgery practices.
authors.affiliation: Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Akhil K
authors.initials: AK
authors.lastname: Seth
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Hirsch
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Bethke
authors.forename: Nora M
authors.initials: NM
authors.lastname: Hansen
authors.forename: Neil A
authors.initials: NA
authors.lastname: Fine
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D013502:General Surgery; D006801:Humans; D007400:Interprofessional Relations; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D012189:Retrospective Studies; D013518:Surgery, Plastic
keywords: Breast reconstruction; Complications; Mastectomy; Outcomes; Surgical team; Surgical voume