Annelotte van Bommel

55 The indicator breast-contour-preserving procedure bodymass index is a limitationof theNBCA. These factorsmaywell affect theeligibility of patients to undergo immediate breast reconstruction. Moreover, the lack of data about delayed reconstruction may limit the interpretation of results since to some extent. In addition, institutional availability and use of oncoplastic surgical techniques aswell as radiotherapy indications have an impact on thedesirability toperformBCSor prosthesis use, respectively. However, data regarding theuseof oncoplastic techniques lacked sufficient detail to take into consideration. Referral patterns betweenhospitals, e.g., patientswhounderwent surgery at an institution another than the hospital where NAC was administered, could not be addressed. Finally, information regarding the achieved and perceived success of BCS as well as of IBR was not available, but would importantly enhance the value of BCPP as an outcome parameter. BCPP provides insight into the various ways in which breast cancer patients can retain their breast contour, and the result reflects combined multidisciplinary efforts. Although it still lacks information about the perceived esthetic outcome, BCPP is an important step in providingmore information than the rate of BCS alone. Achievement of a 100% preservation score is not considered to be an ultimate goal. We acknowledge that multiple factors influence the treatment options that can and will be offered to patients, and the patient’s decision. Notwithstanding these limitations, this study supports the use of theBCPP rate as a local outcome parameter, and an institutional BCPP rate of 75% in patients younger than 70 years may well be defined as an appropriate normvalue for good esthetic outcome of local treatment. CONCLUSIONS BCPP as a composite parameter provides insight into and understanding of the preservation of the breast contour in primary breast cancer patients, appreciating the various ways to maintain the contour of the breast. This study demonstrates that, while the BCS rate remained stable over recent years, the proportion of patients in whom the breast contour was preserved increased while the proportion who underwent a plain mastectomy decreased by one-fifth. At the same time, unexplained institutional differences in the BCS rate persist when applying the rate of BCPP as a quality indicator, and this should motivate future research. 3