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Additional file 3: Table S1. Demographics and disease characteristics II, all variables were analysed per breast, IBLR In-breast local recurrence, NP New primary tumor, DF-Cohort Disease free cohort, D-cohort Disease cohort, IQR interquartile range.

Additional file 2: Figure S2. RFGT. Example of a measurement of residual fibroglandular tissue (RFGT) after nipple sparing mastectomy and reconstruction with an implant. RFGT was identified and measured in the retroareolar region and in the lateral part of the breast.

Additional file 1: Figure S1. FGT volume. Example of a segmentation performed in a right breast before mastectomy with the software ITK-SNAP. A threshold was defined to select the intensity of fibroglandular tissue (FGT) and multiple regions of interest were position in order to segment the whole area of FGT. The segmentation of the volume was performed automatically and the final volume was revised by the reader (board certified breast radiologist). The final measured volume is shown in red.

Additional file 4: Table S2. Reconstruction data, all variables were analysed per breast, IBLR In-breast local recurrence, NP New primary tumor, DF-cohort Disease free cohort, D-cohort Disease cohort.

Summary Background This study investigated the impact of curative breast cancer surgery on patient satisfaction concerning cosmetic results and quality of life (QoL). Methods In this study 61 participants completed questionnaires to evaluate their QoL and patient satisfaction with cosmetic results following breast cancer surgery. Cosmetic outcomes were evaluated by the breast surgeon and an independent breast specialist using the Harris scale and the breast analyzing tool (BAT). Results Of the participants 71% completed all 4 follow-up visits, 38 (62%) patients received breast-conserving therapy (BCT) and 23 (38%) received a mastectomy. Surgery-associated complications arose in 2.6% of the patients who received BCT and 17.4% of patients who received a mastectomy. No significant differences in QoL between BCT patients and mastectomy patients were observed immediately after surgery, or after 6 and 12 months. Breast asymmetry, measured using the BAT score, and QoL scores were worst immediately after surgery. The surgeon rated the cosmetic results as better compared to the independent breast expert (p = 0.001). Furthermore, patients aged over 60 years old were less satisfied with the cosmetic outcome compared to younger patients at the time of discharge (p = 0.024). Patients who received a mastectomy were less satisfied when the resected volume was higher. Conclusion Patient satisfaction was lowest immediately after surgery but improved during the following months, despite continued breast asymmetry. For mastectomy patients, a lower resected volume led to a higher satisfaction with cosmetic results. Satisfaction is subjective and cannot be determined from the esthetic satisfaction of the surgeon or using an objective tool measuring breast asymmetry.