Annelotte van Bommel

132 for DBR creates a time span for patients in which they can explore their possibilities considering different breast reconstruction types and which provides professionals with the ability to assess whether patients are fully prepared for the outcomes. 43 Neo-adjuvant therapy creates a time span to surgery as well. 43 Based on our selection, we did not know on beforehand who had DBR or was considering this; it turned out 24 patients had had DBR. Thirty-eight respondents that had mastectomy without IBR in our study stated they were currently considering DBR; twenty-five of these patients (70%) were informed about IBR before receiving mastectomy. Since time between diagnosis and completing the questionnaire was short for some patients, we presume that moremastectomy patients in our sample eventually will receive DBR. We found that patients with IBR more often felt the decision-making had been shared between themselves and their physician compared to patients without IBR. Several studies have reported variation between actual and preferred involvement in decision-making for breast cancer treatment. 31,44,45 As described above, some mastectomy patients were denied IBR based on tumor or treatment characteristics. Therefore, they might feel they did not have a choice. However, involving patients in the decision-making process should always be promoted, because of its positive effects on quality of life 24 and patient satisfaction. 29–31 Although we did not measure SDM-preferences, we expect that a majority of patients would have wanted to participate in decision-making. 30,31 Besides, Lee et al. reported that the majority of patients in their study felt involved in decision-making, while their knowledge on the procedure of IBR could be improved 46 ; shared decision-making is therefore not the sole result of providing information. Radiotherapy is an accepted reason to omit IBR 20,47 , as it has been shown to increase the risk of implant loss, complications, poorer esthetic results and less satisfied patients. 48 However, these increased complication and failure rates did not seem to apply for immediate autologous reconstructions, with comparable (partly unpublished) results for pre-reconstructive and post-reconstructive exposure to radiation therapy. 49,50 Since implant-based reconstruction is the most applied form of breast reconstruction 48 , which was applicable for our respondents as well, a