Introduction Health outcomes research has gained considerable traction over the past decade as the medical community attempts to move beyond traditional outcome measures such as morbidity and mortality. Since its inception in 2009, the BREAST-Q has provided meaningful and reliable information regarding health related – quality of life (HR-QOL) and patient satisfaction for use in both clinical practice and research. Now five years from its initial publication, we review how researchers have utilized the BREAST-Q and how it has enhanced our understanding and practice of plastic and reconstructive breast surgery. Methods An electronic literature review was performed to identify publications that used the BREAST-Q to assess patient outcomes. Studies developing and/or validating the BREAST-Q or an alternate patient reported outcome measure (PROM), review papers, conference abstracts, discussions, comments and/or responses to previously published papers, studies that modified a version of BREAST-Q, and studies not published in English were excluded. Results Our literature review yielded 214 unique articles, 49 of which met our inclusion criteria. Important trends and highlights were further examined. Discussion The BREAST-Q has provided important insights in breast surgery highlighted by literature concerning autologous reconstruction, implant type, fat grafting, and patient education. The BREAST-Q has increased the use of PROMs in breast surgery and provided numerous important insights in its brief existence. The increased interest in PROMs as well as the under utilized potential of the BREAST-Q should permit its continued use and ability to foster new innovations and improve quality of care.

OBJECTIVE Assess postoperative morbidity and patient reported outcomes following unilateral and bilateral breast reconstruction in patients with unilateral breast cancer. BACKGROUND Relatively little is known about the morbidity associated with and changes in quality of life experienced by patients who undergo contralateral prophylactic mastectomy (CPM) and breast reconstruction. This information would be valuable for decision making in patients with unilateral breast cancer. METHODS Women undergoing mastectomy and breast reconstruction for unilateral breast cancer were recruited for this prospective observational study. Postoperative complications following implant and autologous breast reconstruction in patients undergoing unilateral or bilateral mastectomy were recorded. Preoperative and one year patient reported outcomes were measured. Univariate tests and logistic regression analyses were performed, studying the effects of reconstructive method, laterality, and risk factors on surgical complication rates, patient satisfaction and anxiety. RESULTS We identified 1144 women who underwent either unilateral (47.2%) or bilateral (52.8%) mastectomies with reconstruction. Bilateral autologous (OR 1.73, 95% CI 1.07–2.81) and implant reconstructions (OR 1.73, 95% CI 1.22–2.47) were associated with a higher risk of complications compared to unilateral reconstructions. Baseline anxiety was greater in women who chose bilateral compared to unilateral implant reconstructions (p=0.001). There was no difference in anxiety levels between groups postoperatively. Postoperatively, women who chose CPM with implant reconstructions were more satisfied with their breasts than women with unilateral reconstructions (p=0.034). CONCLUSIONS Though higher postoperative complications were observed following CPM and reconstruction, these procedures were associated with decreased anxiety levels and improved satisfaction with breasts for women who underwent implant reconstructions.

Background Inadequate access to breast reconstruction was a motivating factor underlying passage of the Women’s Health and Cancer Rights Act. It remains unclear whether all patients interested in breast reconstruction undergo this procedure. The aim of this study was to determine whether geographic disparities are present that limit the rate and method of postmastectomy reconstruction. Methods Travel distance in miles between the patient’s residence and the hospital reporting the case was used as a quantitative measure of geographic disparities. The American College of Surgeons National Cancer Database was queried for mastectomy with or without reconstruction performed from 1998 to 2011. Reconstructive procedures were categorized as implant or autologous techniques. Standard statistical tests including linear regression were performed. Results Patients who underwent breast reconstruction had to travel farther than those who had mastectomy alone (p < 0.01). A linear correlation was demonstrated between travel distance and reconstruction rates (p < 0.01). The mean distances traveled by patients who underwent reconstruction at community, comprehensive community, or academic programs were 10.3, 19.9, and 26.2 miles, respectively (p < 0.01). Reconstruction rates were significantly greater at academic programs. Patients traveled farther to undergo autologous compared with prosthetic reconstruction. Conclusions Although greater patient awareness and insurance coverage have contributed to increased breast reconstruction rates in the United States, the presence of geographic barriers suggests an unmet need. Academic programs have the greatest reconstruction rates, but are located farther from patients’ residences. Increasing the number of plastics surgeons, especially in community centers, would be one method of addressing this inequality.

Background Identifying timely and important research questions using relevant patient-reported outcomes (PROs) in surgery remains paramount in the current medical climate. The inaugural Patient-Reported Outcomes in Surgery Conference brought together stakeholders in PROs research in surgery, with the aim of creating a research agenda to help determine future directions and advance cross-disciplinary collaboration. Study Design An iterative Web-based interface was used to create a modified Delphi survey. Participation was limited to conference registrants, which included surgeons, PROs researchers, payers, and other stakeholders. In the first round, research items were generated from qualitative review of responses to open-ended prompts. In the second round, items were ranked using a 5-point Likert scale; attendees were also asked to submit any new items. In the final round, the top 30 items and newly submitted items were redistributed for final ranking using a 3-point Likert scale. The top 20 items by mean rating were selected for the research agenda. Results In round one, participants submitted 459 items, which were reduced to 53 distinct items within seven themes of PROs research. A research agenda was formulated after two successive rounds of ranking. The research agenda identified three themes important for future PROs research in surgery: (1) PROs in the decision-making process, (2) integrating PROs into the EHR and, (3) measuring quality in surgery with PROs. Conclusions The PROS Conference research agenda was created using a modified Delphi survey of stakeholders that will help researchers, surgeons, and funders identify crucial areas of future PROs research in surgery.

Background Optimizing the patient experience is a central pillar in healthcare quality. While this may be recognized as important in breast reconstruction, surgeons are often unaware of how well they and members of their team achieve this goal. The objective of our study was to evaluate patient satisfaction with the experience of care in a multicenter, prospective cohort of patients undergoing breast reconstruction. Specifically, we sought to determine which aspects of the care experience might be most amenable to quality improvement. Methods As part of the Mastectomy Reconstruction Outcomes Consortium Study (MROC), 2,093 patients were recruited from 11 centers in North America. Of these, 1,534 (73.3%) completed the BREAST-Q Satisfaction with Care scales (Satisfaction with Information, Surgeon, Medical team, and Office staff) at three months post-reconstruction and were included in the analysis. Results Patients scored lowest on ‘Satisfaction with Information’ (mean = 72.8) compared to all other Satisfaction with Care scales (means: 89.5 - 95.5). Patients with immediate reconstruction were less satisfied with their plastic surgeon compared to those with delayed reconstruction. The racial category, “Other” (Asians, Pacific Islanders, Hawaiians, American Indians), was the least satisfied group across all Satisfaction with Care scales. Conclusion Patients undergoing breast reconstruction perceive significant gaps in their knowledge and understanding of expected outcomes. Immediate reconstruction patients and minority racial groups may require additional resources and attention. As a means to improve quality of care, these findings highlight an important unmet need and suggest that improving patient education may be central to providing patient-centered care.