title: The Impact of Two Operating Surgeons on Microsurgical Breast Reconstruction.
abstract: BACKGROUND
  Given the complexity of microsurgical breast reconstruction, there are many opportunities to improve both surgical efficiency and outcomes. The use of two operating surgeons has been employed, but the outcomes are unproven. In this study, the authors compare the outcomes of patients undergoing microsurgical breast reconstruction with one operating surgeon to those with two surgeons.
  
  
  METHODS
  A retrospective review of all patients undergoing microsurgical breast reconstruction between July of 2011 and January of 2014 at a single academic institution was conducted. Patients were divided into two cohorts: those undergoing reconstruction with one surgeon and those having reconstruction with two surgeons. Once identified, patients were analyzed and outcomes were compared.
  
  
  RESULTS
  A total of 157 patients underwent 248 microsurgical breast reconstructions during the study period. One hundred three patients (170 flaps) had two surgeons and 54 patients (78 flaps) had one surgeon. Patients undergoing unilateral and bilateral reconstructions with two surgeons had decreased mean operating room time by 60.1 minutes and 134 minutes (p < 0.001) and length of stay by 1.8 days and 1.3 days (p < 0.05), when compared to a single surgeon. Additionally, patients with one surgeon were more likely to have postoperative donor-site breakdown at 5.1 percent (n = 4) versus 0.6 percent (n = 1) (p = 0.0351).
  
  
  CONCLUSIONS
  The use of two operating surgeons has demonstrable effects on the outcomes of microsurgical breast reconstruction. The addition of a second surgeon significantly decreases operating room time and shortens hospital length of stay in both unilateral and bilateral reconstruction. It also significantly decreases donor-site wound healing complications.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: New York and Bronx, N.Y.|From the Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein School of Medicine.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.affiliation: New York and Bronx, N.Y.|From the Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein School of Medicine.
authors.forename: Gretl
authors.initials: G
authors.lastname: Lam
authors.affiliation: New York and Bronx, N.Y.|From the Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein School of Medicine.
authors.forename: Stelios C
authors.initials: SC
authors.lastname: Wilson
authors.affiliation: New York and Bronx, N.Y.|From the Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein School of Medicine.
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Levine
authors.affiliation: New York and Bronx, N.Y.|From the Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein School of Medicine.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Allen
authors.affiliation: New York and Bronx, N.Y.|From the Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein School of Medicine.
authors.forename: Nolan S
authors.initials: NS
authors.lastname: Karp
authors.affiliation: New York and Bronx, N.Y.|From the Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein School of Medicine.
authors.forename: Mihye
authors.initials: M
authors.lastname: Choi
authors.affiliation: New York and Bronx, N.Y.|From the Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein School of Medicine.
authors.forename: Vishal D
authors.initials: VD
authors.lastname: Thanik
mesh_terms: D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D016896:Treatment Outcome