Concurrent Co-surgeon DIEP Flap Breast Reconstructions:

Feasibility and Clinical Outcomes

Christine S. Wang, MD; Abdl-Rawf Al-Nowaylati, MD; Niki Matusko, MS; Adeyiza O. Momoh, MD; Theodore A. Kung, MD

•Deep inferior epigastric perforator (DIEP) is the gold standard for free flap breast reconstruction.

•Co-surgeon model for microvascular breast reconstruction has been associated with improved operative efficiency, decreased post-operative complications, and reduced cost.

•With the need to improve efficiency to meet the increasing demands of breast reconstruction, implantation of a concurrent co-surgeon team approach may be valuable for some microsurgical practices.

•Hypothesis: Performing two concurrent bilateral DIEP flap reconstructions with a co-surgeon team is feasible, increases patient access to care, and results in non-inferior clinical outcomes.

Study Design: Single-institution, retrospective cohort study utilizing medical record review to identify all cases of co-surgeon free flap breast reconstruction from July 2019 to June 2022.

Study group: Patients who underwent bilateral DIEP flap breast reconstruction with same two co-surgeons in concurrent operating rooms on the same day.

Control group: Patients who underwent bilateral DIEP with the same two co-surgeons in one operating room within the same, preceding, or following month of each patient in the study group. 

Patient Characteristics: Age, sex, BMI, tumor laterality, nodal surgery, history of radiation, timing of reconstruction, follow-up length.

Surgical Characteristics: Weight of DIEP flap and mastectomy specimen, quantity of perforators in flap, flow coupler size, trainee experience.

Primary Outcome: Minor and major 90-day post-operative complications.

Secondary Outcome: Operative time, ischemia time, and length of stay.

Statistical Analysis: Patient characteristics and outcomes were compared by groups using chi-square/fisher’s exact test for categorical variables and mann-whitney tests for continuous variables. Multivariable linear regression analysis when indicated.