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Background With the development and refinement of techniques most mastectomy patients nowadays are candidates for breast reconstruction. No one surgical technique fits all, however. Treatment choices are driven by patient characteristics and preferences, alongside policy and operational factors. These, in turn, might be expected to differ on several levels of aggregation, for example, countries, regions, and hospitals. The aim of this study was to compare choices for breast reconstruction timing and modality in Uppsala (Sweden), Maastricht (the Netherlands), and Rome (Italy). Methods In this cross-sectional study, patients presenting for first-time post-mastectomy breast reconstruction in three teaching hospitals were included. The primary study outcomes were breast reconstruction timing and modality. Covariables were body habitus (i.e., body mass index, waist circumference, and mastectomy weight), health-related quality of life assessed with the BREAST-Q Reconstruction module, patient preferences assessed with a self-constructed questionnaire, and shared decision making assessed with the CollaboRATE questionnaire. Statistical tests were used to compare data across study sites. Results Sixty-six participants were included. The most common choices for breast reconstruction timing and modality were delayed DIEP flaps in Uppsala (53%), immediate DIEP flaps in Maastricht (44%), and immediate prepectoral implants in Rome (92%). Participants in Rome were much slenderer than participants in Uppsala and Maastricht (mean body mass index 21.6, 26.2, and 26.3 kg/m2, respectively; p < 0.05). Participants in Uppsala and Maastricht highly valued material used for the reconstruction; participants in Rome were significantly more concerned with complications, scars, and recovery duration associated with the reconstruction. Conclusions This study shows large differences in choices for breast reconstruction timing and modality in Uppsala, Maastricht, and Rome. Possible reasons for

Breast reconstruction procedures have a positive impact on the quality of life of women undergoing breast amputation for therapeutic or prophylactic purposes. The reconstructive plan is made in collaboration with the patient and is adapted to her preferences and priorities. The first part of this thesis describes new techniques and considerations for breast reconstruction with own tissue, autologous breast reconstruction, since not all women are eligible for the standard techniques due to body habitus, previous surgeries or a strong preference for a type of reconstruction. The second part of this thesis describes the impact of breast surgeries on breast sensibility. Results are shared on the efficacy of coaptation of a sensory nerve on the sensory recovery, but most important, the patients quality of life.