Optimizing breast contour preserving possibilities in breast cancer surgery Shaping the future

In this dissertation, we focused on research questions related to improving breast contour preserving surgical options for breast cancer patients, both in the context of breast conserving surgery and in reconstructive possibilities following mastectomy.
First, the dissertation addresses the expansion of indications for breast-conserving surgery. In patients with multifocal or multicentric breast cancer, there are opportunities to perform breast conserving surgery more often, particularly in combination with neoadjuvant systemic therapy. In addition, we show that with two-stage oncoplastic surgical techniques, patients who were initially eligible for mastectomy can still be treated with breast-conserving procedures.
Furthermore, we examined decision-making surrounding immediate breast reconstruction after mastectomy in the Netherlands. Data from the NBCA show that over the past ten years, there have been significant differences between hospitals in the use of immediate reconstructions. Not all patients are eligible for this, and some consciously decide not to undergo reconstruction. Therefore, the goal is not to increase the percentage of immediate reconstructions everywhere, but to understand the reasons behind this variation. To investigate this, the DECIDE study was launched—a prospective SNAPSHOT study involving 45 Dutch hospitals.The results of this research are expected soon.
In the final part of the dissertation, we focus on young women with breast cancer—a patient group that often remains underrepresented in large studies and faces specific challenges in breast cancer care. We investigated the safety of using radioactive iodine seeds as a localization technique in breast-conserving surgery, both during pregnancy and in the breastfeeding period with close contact with the baby. The results show that the use of these seeds is safe in many situations.