130 Chapter 9 ENGLISH SUMMARY In this thesis, various aspects of reconstructive surgery following breast cancer were investigated. Postoperative outcomes and patient satisfaction after oncoplastic breast-conserving surgery were analyzed. The effects of pectoral fascia preservation during a mastectomy were reviewed and discussed. Furthermore, risk factors for implant loss after implant-based breast reconstruction were studied. A validated risk prediction model for implant loss was developed to improve decision-making and pre-operative counseling. PART I – Oncoplastic breast-conserving surgery Cosmetic results after breast cancer treatment have become increasingly important, partly due to improved life expectancy. Oncoplastic breast-conserving surgery (OPS) involves plastic surgery techniques to reconstruct the breast after breast-conserving surgery and aims to improve cosmetic results and oncological safety by obtaining wide resection margins. In the prospective single-center study in chapter 2, complication rates, patient satisfaction and cosmetic outcomes after OPS were evaluated, and differences between volume displacement and volume replacement techniques were analyzed. To measure patient satisfaction, the BREAST-Q was used. Cosmetic outcomes were measured by patient selfevaluation and by evaluation of a panel consisting of two independent plastic surgeons and two laymen, based on medical photographs. An overall complication rate of 18.7% was found, with (surgical) intervention needed in 4%. No differences in complication rates were observed between the two techniques and only the expected differences were noted in physical discomfort and symmetry. Patients were generally satisfied, and cosmetic outcomes were scored good to excellent in 60-86%. Additionally, complications had a negative impact on patient satisfaction and cosmetic results. These results highlight the value of extensive preoperative counseling. PART II – Pectoral fascia preservation in immediate breast reconstruction The pectoral fascia (PF) is a strong fibro-elastic layer and part of the muscular anatomy, rather than the breast glandular tissue. However, removal of the PF during a mastectomy is still part of the standard procedure. It is hypothesized that preservation of the PF might improve postoperative outcomes, such as reducing seroma formation due to its function in lymph drainage, postoperative bleeding and pain by avoiding injury to the pectoralis major muscle, and enhancing implant reconstructions due to additional coverage, without compromising oncological safety. The systematic review in chapter 3 provides a structured overview of the literature regarding mastectomy with PF preservation. The main
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