Minimally invasive approach to diseases of the breast and contemporary factors affecting breast cancer surgery

Pathological nipple discharge is defined as unilateral outflow from the breast. In case of negative imaging, surgery is often recommended in which the milk duct (s) are removed. This operation is under general anaesthesia and may cause problems during breastfeeding. At the same time, malignancy occurs in only 5-8% of patients with pathological nipple discharge. This thesis shows that ductoscopy is more effective than MRI for detecting the cause of the pathological nipple discharge when mammography and/or ultrasound is negative. At the same time, this thesis also shows that this also prevents 60-70% surgery under general anaesthesia, making ductoscopy more cost-effective in the diagnostic work-up compared to MRI. This thesis quantifies the postoperative risk of compilation after robotic nipple-sparing mastectomy and compares this with traditional nipple-sparing mastectomy. Given the similar postoperative risk, this could pave the way for a less invasive alternative for patients eligible for mastectomy. This thesis describes that low socio-economic status in the Netherlands leads to less frequent breast-conserving operations in women with a low breast cancer stage. In addition, women with a low socioeconomic status less often undergo direct breast reconstruction after mastectomy. Finally, this thesis describes the consequences of the COVID-19 pandemic on breast surgery. Fewer women are operated on, most often women with a low tumor stage. This can mainly be explained by the temporary stop of the population screening