Giving meaning to patient reported outcomes in breast reconstruction after mastectomy – A systematic review of available scores and suggestions for further research

Weick, Linn; Brorson, Fredrik; Jepsen, Christian; Lidén, Magnus; Jensen, Emmelie Widmark; Hansson, Emma

doi:10.1016/j.breast.2021.11.008

Cited by 13 publications

(9 citation statements)

References 43 publications

(68 reference statements)

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“…There are no published anchor-based minimal clinically important differences for BREAST-Q. 31 Distribution-based minimal important changes, indicating a difference outside the range of random measurement error, seem to be 11 to 12 points for the satisfaction with the back appearance domain 14 22 and 9 to 10.5 for the physical well-being of the back domain. 14 22 Distribution-based minimal important changes have not been published for physical well-being abdomen.…”

Section: Methodsmentioning

confidence: 96%

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Donor-Site Satisfaction of DIEP and Latissimus Dorsi Flaps—A Comparative Cohort Study

Löfstrand

Paganini

Lidén

et al. 2022

J Reconstr Microsurg

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Background: Understanding of donor site morbidity and satisfaction after breast reconstruction is limited. There are few previous studies comparing satisfaction with different donor sites in breast reconstruction. This study aimed to examine the long-term patient-reported satisfaction with the donor site of latissimus dorsi (LD) flaps in comparison to the deep inferior epigastric artery perforator (DIEP) flaps. Further, a systematic review of previously published studies was conducted. Methods: In this retrospective cross-sectional study, all women who underwent breast reconstructions with either LD or DIEP flap following mastectomy and radiotherapy between 2007-2017 were included; patient-reported satisfaction was assessed using the BREAST-Q reconstruction module. For the systematic review, studies examining patient-reported abdominal satisfaction and well-being, and meeting the PICO (Population, Intervention, Comparison, and Outcome) criteria were included. Results: : Eligible and responding participants were divided into the LD (n=135 patients) and DIEP (n=118 patients) flap groups. Impairment due to muscular weakness of the donor site was more common in the LD group than that of the DIEP group. Bulging was common in the DIEP group and increased over time. Regarding the esthetic appearance of the donor site, the patients in the DIEP group were less satisfied than the LD group. The systematic review showed that most of the patients were dissatisfied with their abdomen after the operation. Conclusion: Patients who have undergone DIEP flap for breast reconstruction are less satisfied with the donor site esthetics than those who have undergone LD flap. Patient-reported abdominal bulging was common in the DIEP group and the number seemed to increase over time. Most patients were not satisfied with their abdominal scarring postoperatively, as per the systematic review. These results may indicate a need for more nuanced preoperative patient information, as well as improvements in the surgical management of the donor site, for DIEP flap reconstructions.

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Section: Methodsmentioning

confidence: 96%

“…14 22 Distribution-based minimal important changes have not been published for physical well-being abdomen. 31 However, normative data regarding the physical well-being abdomen have been described for two American populations, including a total of 1,500 women, with the mean 78 ± 20 32 and 82 ± 18. 33…”

Section: Methodsmentioning

confidence: 99%

Donor-Site Satisfaction of DIEP and Latissimus Dorsi Flaps—A Comparative Cohort Study

Löfstrand

Paganini

Lidén

et al. 2022

J Reconstr Microsurg

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“…The difference between pre-and post-operative BREAST-Q scores were larger than the published distribution-based MIDs for all domains, except for physical well-being chest in the LD-group, indicating that the changes were beyond the measurements error 26,27 . However, to fully interpret the clinical relevance of differences in scores we need knowledge about the clinically relevant MIDs of the instrument, that is anchor based MIDs 25 , and how repeated HrQoL measurements in breast reconstruction patients are affected by other factors, such as response shift, that is the person adapts to his/her situation with time 42 .…”

Section: Discussionmentioning

confidence: 99%

“…Normative data have been described for two American populations including a total of 1500 women 22,23 and one Australian population including 500 women 24 (Electronic supplement 1). There are no anchor-based minimal important differences (MIDs) published for BREAST-Q 25 , but distribution-based MIDs, indicating the lowest change value beyond the measurement error 26,27 , is 4 for Satisfaction with Breasts, 4 for Psychosocial Well-being, 3 for Physical Well-being, and 4 for Sexual Well-being 28 . BREAST-Q has been validated 29,30 and translated to Swedish.…”

Section: Patient Reported Outcomesmentioning

confidence: 99%

Patient Reported Outcome and Quality of Life After Delayed Breast Reconstruction - An RCT Comparing Different Reconstructive Methods in Radiated and Non-radiated Patients

Brorson

Elander

Thórarinsson³

et al. 2022

Clinical Breast Cancer

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“…One aspect to consider when deciding if an operation should be rationed or not could be to evaluate if the woman’s breast related satisfaction and QoL is within statistical normality [ 8 ]. Such an evaluation requires norm values for PROMs, that is knowledge about how the general population of women rate their breast-related satisfaction and QoL [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Swedish Normative Scores for the BREAST-Q Reduction/Mastopexy Module

et al. 2022

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Background Norm values for patient reported outcomes, that is knowledge about how the general population of women rate their breast-related satisfaction and quality of life, are necessary to interpret the meaning of scores. The aims of this study were to create Swedish normative values for the BREAST-Q reduction/mastopexy module and to describe what healthy women are most satisfied/dissatisfied with regarding their breasts. Methods A random sample of 400 women aged 18-80, currently living in Region Västra Götaland, were sent BREAST-Q reduction/mastopexy. Descriptive data are presented. Results One hundred and forty-six women answered the questionnaire (36.5%). Mean total scores ranged from 48 to 78. No clear changes in scores could be seen with age and women with a high BMI seem to be less satisfied with their breasts. The participants were most satisfied with the appearance of the breasts when dressed, the appearance in the mirror dressed, the shape of the breasts with bra, and symmetry of size and most dissatisfied with appearance in the mirror naked and the shape of the breasts without a bra. Thirty to forty-five per cent of healthy women never or almost never feel sexually attractive. Among physical symptoms often described in breast hypertrophy, the most common among healthy women were lack of energy, pain in the neck, arms and shoulders, headache and difficulty performing intense physical activity. Conclusion The norms for BREAST-Q reduction/mastopexy add another piece to the puzzle to what constitutes normal breast satisfaction and how surgical outcomes can be evaluated. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Giving meaning to patient reported outcomes in breast reconstruction after mastectomy – A systematic review of available scores and suggestions for further research

Cited by 13 publications

References 43 publications

Donor-Site Satisfaction of DIEP and Latissimus Dorsi Flaps—A Comparative Cohort Study

Donor-Site Satisfaction of DIEP and Latissimus Dorsi Flaps—A Comparative Cohort Study

Patient Reported Outcome and Quality of Life After Delayed Breast Reconstruction - An RCT Comparing Different Reconstructive Methods in Radiated and Non-radiated Patients

Swedish Normative Scores for the BREAST-Q Reduction/Mastopexy Module

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