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Improving surgical efficiency of immediate implant-based breast reconstruction following mastectomy

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Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Traditionally, during a mastectomy with implant-based reconstruction, the surgical oncologist completes their operative procedure prior to the reconstructive surgeon entering the room. In this scenario, two separate instruments kits and tables are utilized. In our institution, we created a combined instrument kit for use by both surgical teams. We compared set-up and operative times for each process and the subsequent savings associated with this novel approach.

Methods

Sixty-eight patients undergoing mastectomy with implant-based reconstruction were divided into two groups—those who underwent the procedure with separate oncology and reconstructive kits and those who underwent the procedure with combined instrumentation. Set-up time, procedure time, and clinical outcome endpoints were compared. Costs associated with each process were estimated.

Results

Surgical set-up time was lower using the combined kit versus separate kits [mean for unilateral cases, 25.1 ± 9.6 min vs. 35.7 ± 10.4 min (p < 0.01) and mean for bilateral cases, 33.1 ± 10.3 min vs. 43.5 ± 9.9 min (p = 0.31)]. Procedure time was significantly lower using the combined kit versus separate kits [mean for unilateral cases, 156.2 ± 31.7 min vs. 172.1 ± 33.0 min (p < 0.05) and mean for bilateral cases, 207.3 ± 39.3 min vs. 228. 8 ± 42.7 min (p = 0.03)]. Post-operative outcomes were not significantly different between the two groups at 6 months post-surgery (p = 0.72). Due to a decrease in operating room utilization and costs associated with instrumentation, we estimated $134,396 to $206,621 with unilateral cases and a $289,167 to $465,967 in yearly savings with bilateral cases by using the combined process.

Conclusion

Mastectomy with implant-based reconstruction utilizing combined instrumentation, with surgeons working simultaneously, led to decreased operating room utilization and costs without impacting clinical outcomes.

Level of evidence II

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Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA

    Kassandra Nealon & Michelle Specht

  2. Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA

    Kassandra Nealon, Megan Rebello, Nikhil Sobti & Eric C. Liao

  3. Department of Nursing, Massachusetts General Hospital, Boston, MA, USA

    Andrew Sherburne & Dale Spracklin

  4. 15 Parkman Street, WACC 435, Boston, MA, 02114, USA

    Michelle Specht

Authors
  1. Kassandra Nealon
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  2. Megan Rebello
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  3. Nikhil Sobti
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  4. Andrew Sherburne
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  5. Dale Spracklin
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  6. Eric C. Liao
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  7. Michelle Specht
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Corresponding author

Correspondence to Michelle Specht.

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Conflict of interest

Eric Liao M.D. Ph.D has consultant agreements but is explicitly not a speaker for Musculoskeletal Transplant Foundation and Allergan Inc., manufacturers of FlexHD and AlloDerm, respectively. No funds were received for this clinical study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Nealon, K., Rebello, M., Sobti, N. et al. Improving surgical efficiency of immediate implant-based breast reconstruction following mastectomy. Breast Cancer Res Treat 176, 159–164 (2019). https://doi.org/10.1007/s10549-019-05175-2

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  • DOI: https://doi.org/10.1007/s10549-019-05175-2

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