131 English summary outcomes assessed were oncological safety, complication rates, implant loss after reconstructive surgery and cosmetic outcomes following reconstruction. Five studies were included. PF preservation did not affect oncological outcomes in terms of local recurrences, regional and distant metastases, or mortality rates. One study reported a significantly lower incidence of seroma with PF preservation. No significant differences were found for infection or bleeding complications, and no objective data were provided for cosmetic outcomes or reconstructive complications. Overall, the literature on PF preservation is scarce. Based on the current evidence, PF preservation seems to be an oncologically safe procedure that potentially reduces complications. Future research is necessary to systematically assess all relevant outcomes. In the study described in chapter 4, we report on a national survey examining attitudes toward PF preservation among Dutch breast surgeons and plastic surgeons. More than half of the Dutch medical centers contributed to a total of 68 responses. The results show that the PF is routinely preserved by one in five breast surgeons and plastic surgeons, and even more surgeons preserve the PF in specific cases. However, opinions and surgical techniques regarding the PF vary widely between the surgeons. These results indicate this subject remains controversial and that the impact of PF preservation on oncological safety, complication rates, postoperative pain, patient satisfaction, and cosmetic outcomes needs to be clarified in future studies on this topic. PART III – Implant loss risk in implant-based breast reconstruction Following a mastectomy, implant-based breast reconstruction (IBR) remains the most common form of breast reconstruction. Chapter 5 reports a retrospective cohort study that included all patients who underwent a mastectomy followed by either a direct-to-implant (DTI) or two-stage breast reconstruction. Implant loss is the most devastating complication of IBR and had an overall incidence of 11.8% in this cohort. Obesity, a bra cup size greater than C, smoking, a nipple-preserving treatment, a DTI reconstruction, and a smaller surgeon’s volume, were all risk factors significantly associated with implant loss. In this study, a risk model for implant loss was created based on four of these risk factors (obesity, smoking, nipple-preserving procedure, DTI reconstruction) and showed a predicted risk of 8.4-13% in patients with one risk factor, 21.9-32.5% in the presence of two risk factors, 47.5-59.3% in patients with three risk factors and over 78.2% in the presence of four risk factors. The study in chapter 6 aimed to validate the multicenter risk model for implant loss developed in the previous chapter. The validation cohort in this study consisted of 3769 patients who underwent a mastectomy followed by either a two-stage or DTI 9
RkJQdWJsaXNoZXIy MTk4NDMw