title: Does "Two is Better Than One" Apply to Surgeons? Comparing Single-Surgeon Versus Co-surgeon Bilateral Mastectomies.
abstract: BACKGROUND
  Bilateral mastectomies (BM) are traditionally performed by single surgeons (SS); a co-surgeon (CS) technique, where each surgeon concurrently performs a unilateral mastectomy, offers an alternative approach. We examined differences in general surgery time (GST), overall surgery time (OST), and patient complications for BM performed by CS and SS.
  
  
  METHODS
  Patients undergoing BM with tissue expander reconstruction (BMTR) between January 2010 and May 2014 at our center were identified through operative case logs. GST (incision to end of BM procedure), reconstruction duration (RST) (plastic surgery start to end of reconstruction) and OST (OST = GST + RST) was calculated. Patient age, presence/stage of cancer, breast weight, axillary procedure performed, and 30-day postoperative complications were extracted from medical records. Differences in GST and OST between CS and SS cases were assessed with a t test. A multivariate linear regression was fit to identify factors associated with GST.
  
  
  RESULTS
  A total of 116 BMTR cases were performed [CS, n = 67 (57.8 %); SS, n = 49 (42.2 %)]. Demographic characteristics did not differ between groups. GST and OST were significantly shorter for CS cases, 75.8 versus 116.8 min, p < .0001, and 255.2 versus 278.3 min, p = .005, respectively. Presence of a CS significantly reduces BMTR time (β = -38.82, p < .0001). Breast weight (β = 0.0093, p = .03) and axillary dissection (β = 28.69, p = .0003) also impacted GST.
  
  
  CONCLUSIONS
  The CS approach to BMTR reduced both GST and OST; however, the degree of time savings (35.1 and 8.3 %, respectively) was less than hypothesized. A larger study is warranted to better characterize time, cost, and outcomes of the CS-approach for BM.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.|Department of Surgery, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Melissa Anne
authors.initials: MA
authors.lastname: Mallory
authors.affiliation: Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Katya
authors.initials: K
authors.lastname: Losk
authors.affiliation: Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Camuso
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Caterson
authors.affiliation: Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Suniti
authors.initials: S
authors.lastname: Nimbkar
authors.affiliation: Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. MGolshan@partners.org.|Department of Surgery, Dana-Farber Cancer Institute, Boston, MA, USA. MGolshan@partners.org.
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
mesh_terms: D000328:Adult; D018427:Breast Implants; D001943:Breast Neoplasms / Q000150:complications* / Q000601:surgery; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000009:adverse effects*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012189:Retrospective Studies; D066231:Surgeons; D013518:Surgery, Plastic / Q000706:statistics & numerical data*