Annelotte van Bommel

105 Clinicians’ opinion on immediate breast reconstruction About 10% of the respondents reported that comorbidities in general should be regarded as a contra-indication for IBR, irrespective of reconstructive technique. Overall, auto-immune diseases were considered to be a contra-indication by both surgical oncologists and plastic surgeons. The most striking differences between surgical oncologists and plastic surgeons were found for autologous reconstructions. Forty-nine percent of the plastic surgeons compared to 17% of the surgical oncologists mentioned cardiac comorbidities as contra-indication for autologous reconstructions. For pulmonary comorbidities this was the case in 31% of the plastic surgeons versus 10% of the surgical oncologists ( Figure 1 ). Figure 1. Comorbidities indicated as contra-indication per reconstructive technique, separated for surgical oncologists and plastic surgeons. Oncological related contra-indications In general, surgical oncologists reported tumor T-stage and nodal N-stage more frequently as a contra-indication for IBR compared to plastic surgeons. Surgical oncologists reported tumors clinical T3 or larger for all three reconstruction techniques as a contra-indication (around 30%). Plastic surgeons had less agreement on T-stage; cT4 was reported as contra-indication for all reconstruction techniques in 12%, and also T-stages T2 and T3 were reported by 8% of the plastic surgeons, see Figure 2 . Autologous reconstruction Autologous-implant reconstruction Implant reconstruction All co-morbiditeities are a contra-indication Diabetes Mellitus type II Diabetes Mellitus type I Vascular disease Pulmonal disease Cardiac disease Auto-immuun disease Plastic surgeon Surgical oncologist 0%10%20%30%40%50% 0%10%20%30%40%50% 0%10%20%30%40%50% 6