Reply: The Impact of Two Operating Surgeons on Microsurgical Breast Reconstruction

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We read the letter submitted by Dr. Sadideen et al. with great interest. We hope that this article, and others like it, will continue to pique the interest of the Plastic and Reconstructive Surgery readership to explore new ways to improve efficiency in microsurgical breast reconstruction. We believe that our technique, using two microsurgical attending surgeons, has well-documented benefits for patients and the health care system through decreased costs.1 Decreasing operative time and length of stay multiplies this benefit by further decreasing costs and complications.2–7 In addition, we hope that by making these cases simpler and quicker, we can encourage surgeons and patients to increase the rate of autologous breast reconstruction, which has been stagnant in growth for the past 20 years.8
With this in mind, there are numerous ways to increase efficiency in these cases. We certainly agree with the protocol espoused by Sadideen et al., and believe that two experienced operators with well-established roles can be very efficient. Sadideen et al. also make the point that a “regular, consistent scrub/nurse teams plays a crucial role in maximizing operative room efficiency, as frequent changes have a negative impact on surgical performance.” This is a point with which we completely agree, and has enormous impacts on operative efficiency.
In our clinical environment, we have less consistency with the level of fellow/resident assistance and are unable to secure a regular scrub/nurse team or to limit changes during the case. Our system, as described, is helpful in mitigating these potentially negative impacts and ensuring operative efficiency regardless of these variables.
We believe that there are multiple avenues to operative efficiency, and clinicians should tailor their processes dependent on their clinical situation. The critical factor in this discussion is simply the consideration of operative efficiency and using systems-based practices to improve speed and quality in a consistent manner. With these improvements, we hope to both increase the rates of microsurgical breast reconstruction worldwide and improve outcomes.

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