Original article Two surgeons, one patient: The impact of surgeonesurgeon familiarity on patient outcomes following mastectomy with immediate reconstruction Akhil K. Seth a , Elliot M. Hirsch a , John Y.S. Kim a , Kevin P. Bethke b , Nora M. Hansen b , Neil A. Fine a, * a Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA b Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA article info Article history: Received 30 July 2012 Received in revised form 7 February 2013 Accepted 17 April 2013 Keywords: Breast reconstruction Mastectomy Surgical team Complications Surgical voume Outcomes 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 ¼ 511 patients, 699 breasts) with the same mastectomy surgeon but different reconstructive surgeon. Mean follow-up was 38.4 Æ 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 ¼ 384 breasts) were similar to the remaining lower-volume teams (n ¼ 315 breasts). Patient factors, but not the individual surgeon or surgical team, were independent risk factors for complications. Discussion: Our study suggests that among high-volume surgeons, complication rates following mas- tectomy with immediate reconstruction are not affected by the surgeonesurgeon familiarity. The indi- vidual 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 distri- bution model currently used by many breast surgery practices. Ó 2013 Elsevier Ltd. All rights reserved. Background The evaluation of postoperative clinical outcomes has risen to the forefront of surgical research, becoming integral to the rating of surgeons and hospitals, as well as to the development of quality control metrics. 1e6 In particular, within the literature, an emphasis has recently been placed on the potential correlation between surgical volume and subsequent outcomes across multiple surgical disciplines. 7e11 For the surgeon, this relationship appears to be particularly relevant for more complex procedures, where a “learning curve” may play a role in mastery of a technique. 12e15 Meanwhile, at an institutional level, mounting evidence has sug- gested that patients requiring complex surgical intervention or comprehensive multidisciplinary care have improved outcomes when referred to ‘high-volume’ centers. 9e11,16,17 Despite being the most common cancer in women, 18 surgical outcomes following the resection of breast cancer remains a limited area of research. 19e26 Unlike other common oncologic procedures, surgery for breast cancer often involves two distinct, but spatially and temporally related, surgical procedures: mastectomy and im- mediate reconstruction. This requires the coordination of two distinct surgeons, each with their own level of expertise and sur- gical volume. Given the aforementioned research, one would expect that the extent of postoperative success would be * Corresponding author. Division of Plastic Surgery, Northwestern Memorial Hospital, 676 NorthSaint Clair St, Suite 1525A, Chicago, IL 60611, USA. Tel.: þ1 312 266 6240; fax: þ1 312 266 1411. E-mail address: akhil-seth@fsm.northwestern.edu (N.A. Fine). Contents lists available at SciVerse ScienceDirect The Breast journal homepage: www.elsevier.com/brst 0960-9776/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.breast.2013.04.013 The Breast 22 (2013) 914e918