10 Chapter 1 is scarce and opinions and surgical techniques differ between surgeons, medical centers and countries. Implant-Based Reconstruction Implant-based reconstruction is the most common technique for reconstructing the breast following a mastectomy.21 It can be performed in two stages or in one stage (direct-to-implant (DTI)). Generally, the reconstruction is performed in two stages. First, a tissue expander (TE) is placed subpectorally at the time of mastectomy, which is replaced by a definitive implant during a second surgery. The alternative is a DTI approach, where the definitive implant is placed immediately, and no second procedure is indicated. However, with DTI reconstructions, it is more challenging to obtain symmetry and complication rates (including infection, skin necrosis, and implant exposure) may be higher, compared to two-stage procedures.22 Although implant-based reconstruction generally leads to a less natural result compared with an autologous reconstruction, the advantages of implant-based breast reconstructions are the simplicity, safety, and costeffectiveness without potential donor-site morbidity. Furthermore, the operative time is shorter, the overall recovery is quicker and there is a shorter length of hospital stay.23, 24 Among all possible complications, such as surgical site infections (SSI), skin flap necrosis, nipple necrosis, seroma, and hematoma,25 implant loss is the most serious complication, which is observed after 1.8%-16.9% of all implant-based breast reconstructions. It significantly affects the patient’s life in both a physical and emotional manner. Re-operations related to implant loss may cause an important decrease in patient satisfaction and a substantial increase in hospital expenses. It might also postpone the start of additional adjuvant therapy.26-31 Several risk factors for implant loss have been identified in the literature over time, such as advanced age, obesity, smoking status, and DTI reconstruction.27 However, a risk assessment model to improve patient information and decisionmaking regarding the most appropriate type of mastectomy and reconstruction has not been developed yet and would be of great value for better preoperative counseling. Aim and Thesis Outline This thesis aimed to improve patient satisfaction and the postoperative outcomes after reconstructive surgery following breast cancer. Part I of the thesis addresses oncoplastic breast surgery and aimed to analyze whether patients are satisfied after oncoplastic breast surgery and whether there are differences between the two techniques in postoperative outcomes and patient satisfaction. Studies in part II investigated the evolution of mastectomy techniques and focus on pectoral fascia preservation. This part aimed to provide an answer to the following questions: is pectoral fascia preservation oncologically safe, does it improve
RkJQdWJsaXNoZXIy MTk4NDMw