54 Chapter 4 ABSTRACT Background: Pectoral fascia removal during mastectomy still seems to be the standard procedure. However, preservation of the pectoral fascia might improve postoperative and cosmetic outcomes, without compromising oncological safety. Here, we report on a national survey among Dutch plastic surgeons and oncological breast surgeons to evaluate their techniques and opinions regarding the pectoral fascia. Materials and methods: A survey based study was performed in the Netherlands, in which both plastic surgeons and oncological breast surgeons were included, each receiving a different version of the survey. The surveys were distributed to 460 and 150 e-mail addresses, respectively. Results: A total of 68 responses were included from more than half of all Dutch medical centers. The results of this study indicate that circa one in five plastic surgeons and breast surgeons routinely preserve the pectoral fascia during mastectomies, and even more surgeons preserve the pectoral fascia in specific cases. The surgical techniques and opinions regarding pectoral fascia preservation widely differ between surgeons. Conclusion: Preservation of the pectoral fascia does occur in a substantial part of the Dutch medical centers, and techniques and opinions are contradictory. Future studies on this topic should clarify the effect of pectoral fascia preservation on oncological safety, complication rates, postoperative pain, cosmetic outcomes and patient satisfaction.
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