123 General discussion and future directions Finally, for the Dutch reconstructive population at large, the best representable cohort to determine implant loss after IBR consists of DBIR data, implicating the paper described in chapter 7 is of great value and could be used for preoperative counseling in the Dutch practice. Moreover, this paper provides a validated prediction model, where the predicted risk of implant loss can easily be calculated for each patient. As an addition to the Dutch national guideline, in which it is advised not to perform immediate IBR in patients with more than two risk factors, this predicted risk can give more detailed information for the treating physician and the patient in a personalized fashion. The treating physician and patient should together define what is an acceptable risk for them, while keeping alternative options in mind. In patients with an unacceptably high predicted risk, alternative options should be considered, such as an autologous reconstruction, a delayed reconstruction or no reconstruction at all. With a delayed reconstruction, the risk factors BMI and smoking and subsequently the predicted risk can be reduced by lifestyle interventions. In patients with more than one risk factor, prepectoral placement should be avoided. Moreover, if implant loss does occur, previous literature emphasizes the importance of clinical and psychological support,32 and every (plastic) surgeon should strive for full postoperative support of patients who suffered a failed reconstruction. Strengths and limitations This thesis has several strengths and limitations. One of the strengths is that this thesis covers a wide spectrum of reconstructive breast surgery, including implantbased reconstructions after mastectomy and oncoplastic surgery in breastconserving treatments. In addition to the chapters that evaluated reconstructive surgery, the surgical technique of mastectomy was also addressed in this thesis, making it relevant to both plastic and breast surgeons. Finally, an internally validated risk model based on national data was created that could be used in daily clinical practice. In addition, several limitations can be addressed in this thesis. Some of the papers in this thesis were based on data obtained in one or two centers, which hampered the generalizability to the reconstructive population at large. Furthermore, most studies used a retrospective approach, which inevitably resulted in some missing data of interest, weakening the analysis and conclusions. Conclusion This research showed that patients are overall satisfied after OPS and gave positive scores for cosmetic outcomes. In addition, a significant negative effect on these outcomes was observed if a complication occurred. Patients were less satisfied with the breast and with the information provided concerning the surgery, 8
RkJQdWJsaXNoZXIy MTk4NDMw