Annelotte van Bommel

111 Clinicians’ opinion on immediate breast reconstruction their opinions on contra-indications. In addition, recall bias may have occurred since the information was based on self-reports. The result that 100% of the surgical oncologists reported to preoperatively discuss the possibility of IBR with their patients may possibly be an overestimation due to socially desirable answers. Other factors that in literature have been suggested to have a relationship with the use of IBR, like socio-economic status and ethnicity, were not investigated in our study. However, we expect that these factors did not have an impact on the considerations of Dutch clinicians to offer a patient IBR. In the Netherlands, all patients have a healthcare insurance plan and postmastectomy IBR is always fully reimbursed. Lastly, referral patterns and collaboration between disciplines involved in breast cancer care all around the worldmay differ from the Netherlands. However, we feel our results may be representative for attitudes of clinicians in countries with similar constructions between surgical oncologists performing breast cancer surgery and plastic surgeons performing breast reconstruction. Therefore, this study may be a good starting point to exalt the differences found to inspire further research and enable the development of guidelines for discussion and decision-making relevant to potential candidates for IBR. Our findings suggest there are multiple opinions on selecting patients for IBR. Information provision to patients and participation in decision-making should not vary considerably between hospitals or clinicians from different specializations and ideally should not affect IBR rates. Patient selection is crucial to achieve favorable esthetic outcomes with improved quality of life and minimal complication rates. For every individual patient a new trade-off should be made based on her patient and oncological tumor characteristics andpreferences, with some contra-indicationsmore relevant compared to others. This process could be facilitated by evidence-based guidelines, patient decision aid tools and establishment of multidisciplinary teams, ultimately leading to consistent information provision fromevery discipline involved and optimization of shared decision-making. An evidence-based, multi-disciplinary breast reconstruction guideline is publicly available in English since 2015 to guide the decision-making process and to provide the information needed, hopefully resulting in a reduction of variation in personal opinions of physicians towards IBR. 41 6