Annelotte van Bommel

119 Information provision of immediate breast reconstruction INTRODUCTION In 2014, about 14,500 women were diagnosed with invasive breast cancer and 2300 with ductal carcinoma in situ (DCIS) in the Netherlands. 1 Surgical procedures as mastectomy and breast conserving therapy combined with adjuvant radiotherapy have been shown to offer equivalent survival. 2,3 However, loss of one or both breasts mutilates the female appearance and consequently, mastectomy may negatively impact body image and sexuality, leading to feelings of anxiety and depression. 4,5 These effects may be minimized by restoring the contour of the breast with a breast reconstruction. 6–8 Breast reconstruction may be performed either directly after mastectomy in the same operation, which is known as immediate breast reconstruction (IBR), or in a separate operation, sometime after the mastectomy, which is called a delayed breast reconstruction (DBR). 9 IBR can be safely performed without affecting patient survival 10,11 or hampering detection of local recurrences. 10–12 Although in the Netherlands the national guideline on breast cancer treatment recommends considering IBR for every patient needing mastectomy 3 , the average IBR-rate of about 20% was rather low in 2014 13 , albeit comparable to other countries. 14 In the NABON (“National Breast Cancer Consultation the Netherlands”) Breast Cancer Audit (NBCA) 15 we previously demonstrated varying IBR-rates between Dutch hospitals from 0 to 83% (DCIS) and 0–64% (invasive breast cancer), which could not be fully explained by tumor, patient, and hospital factors. 13,16 However, it could well be that other reasons for this observed variation exist, such as preoperative information provision about IBR, shared decision- making (SDM), and patient or physician preferences. Aside from the recommendation to consider IBR in every mastectomy patient, the guideline also recommends physicians to provide sufficient and timely information to patients. 3 In the Netherlands, IBR is performed by plastic surgeons; therefore, consultation between surgeon and plastic surgeon and referral of patients for a consultation with a plastic surgeon is recommended. 17 Although information facilitates SDM 18 , current information provision about IBRmay be insufficient. 19–21 7