Patient-Centered Innovations in Breast Cancer Treatment: Optimizing Clinical Outcomes and Quality of Life after Breast Cancer Surgery

Breast cancer treatment has changed considerably over recent decades. Earlier detection and advances in treatment have substantially improved survival, increasing the importance of outcomes beyond oncological safety alone. Consequently, the impact of treatment on patients’ physical, psychosocial and long-term quality of life has become increasingly relevant. This thesis investigated how innovations in breast cancer surgery can contribute to more evidence-based and patient-centered care.

Several aspects of surgical treatment were evaluated. A PECS II nerve block provided no clinically meaningful reduction in postoperative pain or analgesic requirements following conventional breast-conserving surgery. In contrast, fluorescence imaging using Indocyanine Green (ICG) proved a safe and effective method for intra-operative sentinel lymph node detection and represents a promising alternative to conventional radioactive tracers.

Different surgical and reconstructive strategies were also compared. Oncoplastic breast-conserving surgery showed comparable clinical outcomes to conventional breast-conserving surgery, although patients reported less favorable outcomes during early recovery. Immediate autologous breast reconstruction did not appear to increase the risk of breast cancer recurrence compared with delayed reconstruction. Among patients receiving postmastectomy radiotherapy, immediate and delayed DIEP-flap reconstruction were associated with different advantages and disadvantages, with neither approach being universally superior. Finally, nationwide registry data identified several patient-, hospital- and surgery-related factors associated with unplanned re-operations during two-stage implant-based breast reconstruction.

Overall, this thesis demonstrates that successful surgical innovation does not necessarily mean providing more treatment. Innovations should offer meaningful benefits to patients while maintaining oncological safety. Combining clinical outcomes with patient-reported outcomes enables better counselling and supports shared decision-making, allowing surgical treatment to be tailored to each patient’s individual risks, needs and preferences.