Flow charts improve efficiency and education during bilateral complex reconstructive surgery of the breasts.

: Free flap surgery for breast reconstruction using abdominal, gluteal and thigh perforator flaps is now routine. It has been extended to "challenging" groups of patients such as the obese, the elderly, and those with multiple scars. However, bilateral free flap reconstruction is still demanding, especially when performed at the same time as the mastectomy. For healthcare staff new to bilateral immediate reconstruction-be they scrub nurses, technicians, junior doctors, or anesthetists-the operative process is not only lengthy but also confusing because it involves multiple steps and operating theatre teams. To simplify the process, we have designed flow charts that map out the course of the operations. We have found that these pictorial representations not only educate staff but also increase the efficiency of the entire procedure. This general principle of utilizing a flow chart to outline complex surgery can be applied to many different types of operations besides breast reconstruction.