Abstract
Background Autologous breast reconstruction has been noted in the literature to provide superior
aesthetic outcomes and patient satisfaction. Additionally, free perforator flap tissue
transfer has the potential for lower abdominal donor site morbidity. However, it has
been noted that the percentage of women who are undergoing autologous breast reconstruction
in the United States is decreasing. Factors related to the technical difficulty, prolonged
operative times, and decreasing reimbursement have been implicated as the causes.
Methods A retrospective review of electronic medical records over a 5-year period was performed
with evaluation of 77 autologous breast reconstructions at a single institution. Patient
demographics, comorbidities, number of surgeons involved, operative times, length
of stay, and postoperative complications were measured. Wilcoxon rank-sum, Pearson's
chi-squared, and proportional odds likelihood ratio tests were performed to compare
continuous, categorical, and ordinal outcomes, respectively. Propensity score weighting
was used to adjust for presurgical covariates and laterality.
Results Operative time and length of stay were both significantly lower in the two- versus
the single-microsurgeon groups in the unadjusted setting. When covariates and laterality
were adjusted for, operative times still remained significantly shorter in the two-microsurgeon
group; there were no differences in complications.
Conclusion Based on our findings, we propose that the two-microsurgeon approach can be utilized
in more time-consuming microsurgical cases, such as autologous breast reconstruction,
to safely decrease operative times and potentially alleviate surgeon fatigue, reduce
operative costs, and thus increase overall surgeon productivity.
Keywords
two-microsurgeon - autologous breast reconstruction - free flap
