Annelotte van Bommel

155 Quality of life after immediate breast reconstruction place to achieve locoregional control of breast cancer. Learning from patient preferences and outcomes of breast cancer surgery guides us through a better understanding of the actual care given. PROMs as the BREAST-Q enable us to understand outcomes beyondmortality and survival rates and to identify outcomes that also matter to patients. Several other studies have examined health-related quality of life in patient populations followingmastectomywithversuswithout IBRusing theBREAST-Q. 21,22,23 Most studies showed similar results for psychosocial and sexual functioning favoring IBR. They also demonstrated a less apparent difference in physical functioning using multivariate regression analyses. 21,22,23 A common finding of these previous and our current study was that patients consistently reported lowest scores for sexual well- being. However, these low scores were also reported in a general population of women without breast cancer treatment, indicating that the low sexual well-being scores may also reflect an overall satisfaction of sexual well-being at a certain age instead of alterations due to breast cancer treatment only. 24 Unexpectedly, the present study did not show a significant difference in the BREAST-Q domain “satisfaction with breasts” and both patient groups had similar scores compared to normative data. 24 However, this finding is contradictory to the results of previous studies. 21,22,23 An explanation might be that patients without IBR accept the esthetic consequences for the chest area. This is supported by the additional comments found in the survey where 16 patients stated they deliberately decided not to undergo IBR. Patient satisfaction with their breasts is also significantly associated with preoperative information provision by and shared decision-making with the reconstructive surgeon, which highlights the importance of adequate preoperative information provision. 25 Only the outcome domain “physical well-being” was lower compared to normative data which are used internationally. 24 Patients who had received either mastectomy or IBR scored around 75 compared to the normative score of 93. 24 A recent single center study in the Netherlands investigating a breast cancer population showed mean data of around 70. 23 Surgery in general, including reconstructive surgery, 8