Annelotte van Bommel

99 Clinicians’ opinion on immediate breast reconstruction INTRODUCTION In the Netherlands, about 15,000 new breast cancer patients are diagnosed annually, which makes it the most frequently diagnosed cancer in women. 1 About 40% of all surgically treated patients receive a mastectomy. 2 According to current guidelines, immediate breast reconstruction (IBR) has to be considered in every patient who is planned for mastectomy. 3,4 IBR does not compromise the oncological outcomes, 5 while resulting in improved quality of life with better psychological and functional wellbeing in the majority of patients. 6–9 In general, breast reconstruction can be performed with an implant, autologous tissue or using a combination of both. However, implant reconstructions are performed most frequently. 10–13 These different techniques vary in complexity and operation time, complication rates, recovery period and esthetic outcomes, making not every technique suitable for every patient, depending on comorbidities, local anatomy and previous surgery or other treatment, and patient preferences. 14–16 The NABON Breast Cancer Audit (NBCA) is a nationwide multidisciplinary audit measuring quality of breast cancer care in the Netherlands. 17 Current data show that the mean percentage of patients undergoing IBR in the Netherlands is rather low given every patient planned for mastectomy should be considered for IBR; 17% for invasive breast cancer and 43% for ductal carcinoma in situ (DCIS). 2,17 Immediate implant based reconstructions were performedmost frequently (89%). Autologous or a combination of autologous and implant reconstructions were both used in less than 5% of the patients who underwent IBR for invasive breast cancer. 11 Moreover, large variation in the use of IBR between hospitals in theNetherlands was previously shown by our group; 0–64% and 0–83% for invasive breast cancer and DCIS, respectively. 11 Numerous factors are considered contra-indications for the use of IBR which may affect its current use. Patient characteristics such as older age, high BodyMass Index (BMI), smoking status, comorbidities have been reported to affect the probability to receive IBR. 18,19 In addition, tumor factors as histology, larger tumor size and lymph node involvement also have an impact on whether or not IBR is performed as well as the need for adjuvant treatments. 6,18,20–22 Furthermore, 6