Annelotte van Bommel

147 Quality of life after immediate breast reconstruction INTRODUCTION Against the background of good prognosis and limited local treatment associated morbidity for primary breast cancer patients who undergo curative treatment 1 , attention shifts to maintaining quality of life as an important goal of care. Quality of life can be objectified through patient-reported outcome measures (PROMs). PROMs aim to assess the actual feelings and thoughts of a patient and help clinicians and patients to measure, interpret, and understand quality of life as perceived by the patient. 2 As such, it may enhance communication between clinicians and patients in shared decision-making. In addition, PROMs may be used for comparative effectiveness analyses and to monitor quality of care. 3,4 Approximately 40% of patients with invasive breast cancer and 30% of patients with ductal carcinoma in situ (DCIS) undergo mastectomy in the Netherlands. 5 To restore the breast contour, breast reconstruction may be performed either at the time of initial breast cancer surgery (immediate breast reconstruction, IBR) or as a delayed procedure some time later. 6 IBR has positive effects on body image and psychosocial well-being 7,8 and current guidelines recommend to offer IBR to every patient with an indication for mastectomy. 9,10,11 Nonetheless, a rather low mean IBR rate of 18% for patients undergoing mastectomy for invasive breast cancer was observed in the Netherlands and IBR-rates varied substantially between Dutch hospitals. 12,13 In previous studies, case-mix variation 12 , hospital organizational factors 14 , attitudes of clinicians towards IBR 15 , and information provision about IBR were identified as possible causes of this hospital variation 16 . Even after adjustment for tumor, patient and hospital variables, IBR rates varied from0% to 64%between hospitals in the Netherlands. 12,14 To investigate the clinical significance of the observed variation of IBR rates in terms of patient-reported quality of life, the aim of the present study was to compare health-related quality of life of breast cancer patients treated with mastectomy with IBR versus mastectomy without IBR. 8