Annelotte van Bommel

71 Variation in immediate breast reconstruction In the present study, we investigated the possible effect of patient and tumor characteristics on the use of IBR. In accordance with other studies, we found that a younger age was significantly related with higher IBR rates. 2,8,12,13 This findingmay be explained by both clinician beliefs and patient preferences. Younger patients may be more aware of and more interested in the possibility of IBR, and they may be more assertive to discuss reconstructive options. Clinicians in turnmay consider younger patients to bemore eligible to undergo a reconstruction. In addition, older patients are more likely to have significant comorbidities leading to the decision to not perform IBR, may more easily accept the loss of their breast(s), or may not want to undergo major surgery. Patients with an early-stage tumor had a higher likelihood of receiving IBR, which was also consistent with literature. 2,8 Locoregionally advanced tumors require adjuvant therapies such as radiotherapy and chemotherapy more often, even after a mastectomy. Patients with an indication for adjuvant therapies, particularly radiotherapy, have a lower chance of being treated with IBR. 14 There is still much debate on the timing and type of reconstruction in case radiotherapy is needed. 15–17 Particularly in implant-based reconstructions, radiotherapy leads to a significantly higher reconstruction failure rate compared to patients without radiotherapy. 18 In cases where patients require radiotherapy, clinicians may decide not to perform IBR as most reconstructions are implant based. It is recommended to perform an autologous flap technique when radiotherapy is required because radiotherapy- related complications of the autologous flap are less frequent and less severe. 15 In case of adjuvant chemotherapy, it is not the fear of increased chance of IBR complications but the delay IBR may cause to initiate adjuvant chemotherapy. However, a recent review found that IBR does not necessarily delay the start of adjuvant chemotherapy to a clinically relevant extent. 19 The presence of a multifocal cancer was associated with a higher rate of postmastectomy IBR. Although multifocality may explain the propensity to prefer ablative surgery in these patients because of the size of the involved breast area, the size of the individual lesions will rarely be a reason to abstain from IBR. The observation that IBR was more frequent in patients treated for DCIS than those 4