118 Chapter 8 DISCUSSION The overall aim of this thesis was to analyze postoperative outcomes and patient satisfaction after reconstructive surgery following breast cancer. Different aspects of reconstructive breast surgery were assessed, focusing on oncoplastic breastconserving surgery (part I), a less extensive mastectomy technique with pectoral fascia preservation (part II) and the risk of implant loss after implant-based breast reconstruction (part III). Oncoplastic breast-conserving surgery Oncoplastic breast-conserving surgery (OPS) has gained popularity in the past decades and has shown to be a reliable and effective way to reconstruct the breast after breast-conserving surgery.1 Studies have shown similar rates of diseasefree survival and local recurrence rates, compared to breast-conserving surgery alone, and association with increased patient satisfaction and favorable cosmetic outcomes.2 This thesis provided additional evidence that patients in general are pleased with the outcomes after OPS. Chapter 2 showed that patients were overall satisfied after OPS, as measured with the BREAST-Q, with 86% of patients rating their cosmetic outcomes as good to excellent. However, patients who underwent volume replacement techniques reported significantly lower scores for the BREAST-Q domain “well-being of the chest”, which may be the result of more extensive surgery that is required for this technique. Further comparison of volume replacement with volume displacement techniques revealed similar complication rates, in contrast to the study of Clough et al, in which more complex reshaping techniques lead to higher complication rates.3 This thesis also highlighted the association between complications and patient satisfaction. In patients who underwent OPS, the occurrence of complications resulted in decreased BREAST-Q scores and cosmetic outcome scores. Patients with complications were less satisfied with their breast(s) and with the information provided concerning the surgery. This association was also reported in a systematic review from 2016, which found that patients with complications experienced a significantly worse quality of life and other psychosocial outcomes, with long term effects, compared to patients without complications.4 The importance of adequate preoperative information provision was also appointed in previous literature. One study interviewed patients after a failed breast reconstruction. The necessity for adequate preoperative information concerning the psychological impact was brought up most frequently. After a failed breast reconstruction, explicit recognition of the patients’ suffering and emotional wellbeing by the plastic surgeon is a crucial component of recovery for all patients.5
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