29 Outcomes following oncoplastic breast surgery OPS. This is in line with recent research, including 1871 breast cancer patients after various procedures in which the EQ-5D questionnaire was used to value the effect of surgical complications. This study showed that complications resulted in poorer health-related quality of life.30 Furthermore, complications leading to inferior cosmetic outcomes were expected, as they may lead to skin retractions contributing to asymmetry or a lower global aesthetic judgment, even though the expected influence on scarring was not found. There are several limitations of this study. First of all, the data were obtained in one study center, and may not be generalizable to the oncoplastic reconstructive population at large. Second, patients completed the BREAST-Q at variable time points after surgery, which could lead to recall bias, especially for the patient reported experience measures. Furthermore, no preoperative BREAST-Q was available for comparison. Third, patient reported cosmetic outcomes and the cosmetic panel evaluation were assessed at different time points and no explanation of the given score was obtained. Fourth, general quality of life, next to breast related quality of life, was not assessed in this study. Finally, the small sample size and limited number of available postoperative photographs (57.1%) resulted in the inability to accurately assess for confounding, such as patient characteristics, surgical characteristics and adjuvant therapies. Future studies, preferably with a larger sample size and multicenter design, should implement both BREAST-Q and medical photographs in a standard protocol, involving more frequent and fixed time points. In conclusion, postoperative complications were observed in 18.7% of patients after OPS, which required (surgical) intervention in only in 4%. No differences in complication rates were observed between techniques. Furthermore, 60-86% of cosmetic outcomes were scored good to excellent, in which patients given the highest scored followed by the plastic surgeons and laymen. Volume displacement or replacement was performed for different indications and generally showed comparable results. Expected differences in physical discomfort and symmetry between both techniques were observed. The occurrence of complications resulted in lower BREAST-Q scores and cosmetic outcome scores. Ultimately, these insights could be used to thoroughly counsel patients by using information from patient, specialist and laymen experience. 2
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