Annelotte van Bommel

13 - Practice patterns and hospital variationwith respect to the treated population of patients who underwent immediate breast reconstruction following mastectomy for restoration of their breast mound is analyzed in Chapter 4 . To adjust for institutional differences, this chapter analyzes which patient and tumor case-mix factors contribute to the observed hospital variation and to what extent variation remains after adjustment for these factors. - Aside from patient case-mix factors, hospital and hospital organizational factors affecting the use of immediate breast reconstruction after mastectomy for ductal carcinoma in situ (DCIS) and invasive breast cancer are investigated in Chapter 5 . - Trying to identify all possible factors affecting the use of immediate breast reconstruction led to the analyses in Chapter 6 , evaluating differences in the attitudes of surgeons and plastic surgeons towards immediate breast reconstruction following mastectomy. - The effect of being informed about immediate breast reconstruction on the likelihood of receiving an immediate breast reconstruction accentuates the importance of pre-operative information provision, which is described in Chapter 7 . - In Chapter 8 a breast surgery specific PROM is used to compare quality of life of patients after mastectomy with immediate breast reconstruction and following mastectomy only, because patient-reported outcomes are important to improve counseling and shared decision-making of all patients treated for breast cancer. 1 Introduction