56 Chapter 4 was sent to 150 e-mail addresses by the NVCO and in a newsletter of the clinical research center of the Leiden University Medical Center two months later. As the breast surgeon response rate (RR) was low, the survey was resent directly to nonresponding breast surgeons. The RR calculation was based on the total amount of e-mail addresses of plastic surgeons registered by the NVPC and of breast surgeons registered by the NVCO to whom the surveys were sent to, which were 460 and 150 e-mail addresses, respectively. RESULTS A total of 68 responses were included, consisting of 46 plastic surgeons (RR 10%) and 22 breast surgeons (RR 15%) from 41 different medical centers. These represent more than half of all Dutch medical centers (59%), and included both academic and peripheral medical centers, one oncological center and one specialized breast cancer center. Plastic surgeons Of all plastic surgeons, 17% indicated that the PF was preserved at all times during a mastectomy with an immediate reconstruction; 44% answered that the PF was never preserved; 33% answered that the PF was preserved in some cases; and 7% did not know whether the PF was preserved or excised. According to the plastic surgeons who responded that the PF was never preserved, oncological safety was the main reason (80%). Of all plastic surgery respondents, 57% believed that PF preservation may improve implant coverage, 44% that it may reduce complication rates, and 28% that it may improve cosmetic outcomes. Breast surgeons Of all breast surgeons, 18% responded that the PF was preserved at all times; 64% responded that the PF was routinely excised; and 18% responded that the PF was preserved only in those cases when the tumor is located at a safe distance from the fascia, which varied between 1 mm and 2 cm. This distance is set intraoperatively in 25% and preoperatively in 75% by using mammography (50%) or MRI (50%). According to the breast surgeons who responded that the PF was excised, oncological safety was the main reason (50%), followed by not being familiar with this technique (29%). In this group, 21% does exceptionally preserve the PF in prophylactic mastectomies. Questions and responses of the plastic surgeons and breast surgeons are shown in Figure 1 and Figure 2, respectively.
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