title: Single dual-trained surgeon for breast care leads to higher reconstruction rates after mastectomy.
abstract: BACKGROUND
  Breast reconstruction improves the quality of life for mastectomy patients but is underutilized in the United States. This study investigated reconstruction rates for a dual-trained oncologic plastic surgeon to explore how provider-based factors influence reconstruction.
  
  
  METHODS
  We evaluated consecutive mastectomy patients treated at the University of California, San Diego Medical Center between 2009 and 2012. We identified mastectomy patients based on Current Procedural Terminology codes and evaluated them for patient- and disease-specific variables. We evaluated reconstruction rates for the traditional team model of collaborating plastic and oncologic surgeons versus a single surgeon, dual trained in surgical breast oncology and plastic surgery. A multivariate regression analysis was then used to identify the significant predictors of reconstruction.
  
  
  RESULTS
  Mastectomy was performed in 344 patients. The surgeon group was a significant predictor of postmastectomy reconstruction (p < 0.05). The traditional team of oncologic and plastic surgeons reconstructed 93 (63.3 %) of 147 mastectomy patients, whereas the single dual-trained surgeon reconstructed 140 (71.1 %) of 197 mastectomy patients. Race and insurance status did not influence the receipt of reconstruction in our single-surgeon model, however, patients of older age [odds ratio (OR) 0.93, confidence interval (CI) 0.89-0.98, p < 0.01], higher body mass index (OR 0.89, CI 0.82-0.97, p < 0.01), or more advanced disease (p < 0.01) were less likely to undergo reconstruction.
  
  
  CONCLUSIONS
  A single dual-trained surgeon for breast care influences reconstruction rates. A dual-trained surgeon increases the likelihood of reconstruction and obtains rates higher than previously reported. This may reflect the comprehensive care provided by a multidisciplinary-trained professional. A single surgeon providing care in oncology and reconstruction represents a comprehensive approach to breast care and demonstrates a relationship between provider practice and breast reconstruction.
authors: Division of Plastic Surgery, Department of Surgery, University of California San Diego School of Medicine, 3855 Health Sciences Drive, MC 8890, La Jolla, CA, 92093, USA, ashaterian@gmail.com.
authors: Ashkaun
authors: A
authors: Shaterian
authors: Salim C
authors: SC
authors: Saba
authors: Brittany
authors: B
authors: Yee
authors: Christopher
authors: C
authors: Tokin
authors: Brian
authors: B
authors: Mailey
authors: Marek K
authors: MK
authors: Dobke
authors: Anne M
authors: AM
authors: Wallace
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D002140:California; D002983:Clinical Competence; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011788:Quality of Life; D012189:Retrospective Studies
references: Plast Reconstr Surg. 2000 Oct;106(5):1014-25; discussion 1026-7
references: 11039373
references: J Am Coll Surg. 2012 Mar;214(3):270-6
references: 22225646
references: Semin Plast Surg. 2004 May;18(2):149-55
references: 20574493
references: Ann Surg. 2008 Jun;247(6):1019-28
references: 18520230
references: Am J Surg. 2009 Aug;198(2):237-43
references: 19306977
references: Can J Surg. 2008 Dec;51(6):447-52
references: 19057733
references: Surgery. 1994 Jun;115(6):663-8
references: 8197555
references: J Am Coll Surg. 2008 Apr;206(4):605-15
references: 18387464
references: Cancer. 2008 Feb 1;112(3):489-94
references: 18157830
references: N Engl J Med. 2008 Oct 9;359(15):1590-601
references: 18843123
references: Plast Reconstr Surg. 2008 Jun;121(6):1893-1899
references: 18520874
references: CA Cancer J Clin. 2011 Jul-Aug;61(4):212-36
references: 21685461
references: Cancer Treat Rev. 2011 Aug;37(5):353-7
references: 21371824
references: Ann Surg Oncol. 2001 Aug;8(7):586-91
references: 11508620
references: Ann Surg. 2006 Feb;243(2):241-9
references: 16432358
references: J Am Coll Surg. 2001 Jan;192(1):1-8
references: 11192909
references: Plast Reconstr Surg. 2007 Jun;119(7):2008-2015
references: 17519692
references: Plast Reconstr Surg. 2003 Feb;111(2):695-703; discussion 704-5
references: 12560690
references: N Engl J Med. 1992 Apr 23;326(17):1102-7
references: 1552911
references: Breast. 2011 Aug;20(4):373-9
references: 21376594
references: Am J Surg. 2001 Dec;182(6):649-53
references: 11839332
references: Breast J. 2010 Nov-Dec;16(6):587-97
references: 21070435
references: Int J Clin Pract. 2006 Apr;60(4):471-4
references: 16620362
references: Ann Surg Oncol. 2011 Aug;18(8):2158-65
references: 21308486
references: JAMA. 2006 Jan 25;295(4):387-8
references: 16434628