11 General Introduction and outline of this thesis postoperative outcomes and do surgeons actually use this technique in the Dutch practice? Part III contains studies concerning implant-based breast reconstruction and aimed to create a validated risk prediction model for implant loss. Part I – Oncoplastic breast surgery In chapter 2, oncoplastic breast surgery and the postoperative outcomes are discussed. The study focuses on complications, patient satisfaction and cosmetic outcomes. Furthermore, the outcomes of the two different techniques, volume replacement and volume displacement, were analyzed and compared. Part II – Pectoral fascia preservation in immediate breast reconstruction Pectoral fascia removal during a mastectomy is still common practice in the Netherlands. Chapter 3 provides an overview of literature concerning pectoral fascia preservation during a mastectomy, with the main outcomes oncological safety, complication rates, implant loss and cosmetic outcomes. In addition to this topic, chapter 4 reports on a nation-wide survey on the opinions of Dutch plastic surgeons and breast surgeons regarding pectoral fascia preservation. Part III – Implant loss in implant-based breast reconstruction Implant loss is the most feared complication following implant-based reconstructions. Therefore, significant risk factors for implant loss following implant-based reconstructions were identified in chapter 5 and a multi-center risk model for implant loss was created. The study in chapter 6 aimed to validate the risk model for implant loss, which was developed in the previous chapter using data from the Dutch Breast Implant Registry (DBIR). The study in chapter 7 aimed to create a validated risk prediction model for implant loss with DBIR data which would be very useful in decision-making and preoperative counseling for women who consider implant-based reconstruction. Finally, in chapter 8, the main findings and conclusion of this thesis are discussed and suggestions for future research are provided. 1
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