Measuring the patient perspective on latissimus dorsi donor site outcomes following breast reconstruction

Browne, John; Jeevan, Ranjeet; Pusic, Andrea L.; Klassen, Anne F.; Gulliver-Clarke, Carmel; Pereira, Jerome; Caddy, Christopher M.; Cano, Stefan

doi:10.1016/j.bjps.2017.08.028

Cited by 16 publications

(27 citation statements)

References 13 publications

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“…The finding of LD harvest-associated morbidity is supported by systematic reviews of the literature on LD flaps [39,40]. However, the evidence on functional morbidity associated with LD flap harvest is still ambiguous [22,37,[40][41][42][43]. The follow-up time in most studies examining morbidities and consequences of harvesting the LD flap is relatively short.…”

Section: Discussionmentioning

confidence: 99%

Thoracodorsal artery flaps for breast reconstruction–the variants and its approach

et al. 2021

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Thoracodorsal artery (TDA) flaps, ranging from the vascular-pedicled thoracodorsal artery perforator (TDAP) flap, the propeller TDAP flap, and the muscle-sparing latissimus dorsi (MSLD) flap to the conventional latissimus dorsi (LD) flap and the extended LD flap, can all be used for breast reconstruction. The aim of this paper and review is to share our experiences and recommendations for procedure selection when applying TDA-based flaps for breast reconstruction. We describe the different surgical techniques and our thoughts and experience regarding indications and selection between these procedures for individual patients who opt for breast reconstruction. We have performed 574 TDA flaps in 491 patients: 60 extended LD flaps, 122 conventional LD flaps, two MSLD flaps, 233 propeller TDAP flaps, 122 TDAP flaps, and 35 free contralateral TDAP flaps for stacked TDAP breast reconstruction. All the TDA flaps are important flaps for reconstruction of the breast. The LD flap is still an option, although we prefer flaps without muscle when possible. The vascular-pedicled TDAP flap is an option for experienced surgeons, and the propeller TDAP flap can be used in most reconstructive cases of the breast, although a secondary procedure is often necessary for correction of the pedicle bulk. The extended LD flap is an option for women with a substantial body mass index, although it is associated with the highest morbidity of all the TDA flaps. The MSLD flap can be used if the perforators are small or if dissection of the perforators is assessed to be hazardous.

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Section: Discussionmentioning

confidence: 99%

Thoracodorsal artery flaps for breast reconstruction–the variants and its approach

et al. 2021

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“…The BREAST-Q LD questionnaire includes two scales: Satisfaction with back appearance, with 8 questions (items) and Satisfaction with back and shoulder function, with 11 questions, asking patients to rate how often they have been bothered by problems during the last 2 weeks on a five-point scale ranging from ‘none of the time’ to ‘all of the time’ [ 6 ]. The items of the scales were developed using a qualitative methodology in the United States [ 6 ], and was subsequently validated in a British population [ 6 ], resulting in an 8-item Satisfaction with back appearance scale and an 11-item Satisfaction with back and shoulder function scale.…”

Section: Methodsmentioning

confidence: 99%

“…The scales were validated [ 6 ] using the Rasch measurement model, generating a conversion table in which sum scores of the scales (8–40 [ 14 ] and 11–55 [ 15 ], respectively) were converted to equivalent Rasch transformed scores (0–100). A higher score represents a better outcome [ 6 ]. Both scales had good internal consistency (Cronbach’s α = 0.95 and 0.94, respectively) and high corrected item-total correlations (range 0.75–0.86 and 0.61–0.83, respectively).…”

Section: Methodsmentioning

confidence: 99%

“…The instrument includes questions on complications and consequences of implants and of donor-site morbidity of abdominally based flaps [ 4 ]. However, as donor-site morbidity of other types of reconstructions are lacking, the BREAST-Q latissimus dorsi (LD) questionnaire was recently developed [ 6 ] as a complement to the general BREAST-Q reconstruction module.…”

Section: Introductionmentioning

confidence: 99%

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Validation and reliability testing of the Breast-Q latissimus dorsi questionnaire: cross-cultural adaptation and psychometric properties in a Swedish population

Kamya

Hansson

Weick

2021

Health Qual Life Outcomes

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Background The main aim of post-mastectomy breast reconstruction is to improve the patient’s quality of life, which makes high-quality and validated patient-reported outcome measurements essential. None of the established instruments include evaluation of donor-site morbidity, such as impact on upper extremity and back function, when a latissimus dorsi (LD) muscle is used; and BREAST-Q LD questionnaire was therefore recently developed for this purpose. The aim of this study was to translate into Swedish and culturally adapt the BREAST-Q LD questionnaire’s two subscales, appearance and function, and perform a psychometric evaluation of the subscales in a Swedish population of patients. Methods This was a cross-sectional study. The questionnaire was translated according to established guidelines. The questionnaires were sent to all patients operated using an LD flap between 2007 and 2017. Internal consistency was assessed using Cronbach’s α. Inter-item correlations and corrected item-total correlations were calculated using the Pearson’s correlation coefficient. Convergent validity was evaluated by comparing the BREAST-Q LD questionnaire to the Western Ontario Osteoarthritis of the Shoulder Index, using the Spearman correlation coefficient. Test–retest reliability was tested with intraclass correlation coefficients (ICCs), and the coefficient of variation and Bland–Altman plots were drawn. Floor and ceiling effects were calculated. Known-group validation was tested by comparing scores from the patients and from normal controls using the Mann–Whitney U-test and by calculating eta squared effect size. Results The questionnaires were sent to 176 eligible patients and 125 responded (71%). The patients had been operated a mean of 6.6 years ago, and most (92%) had previous radiation. Internal consistency was satisfactory for both subscales. The correlation coefficients between questions were r > 0.30 for all items of both scales. The corrected item-total correlation coefficient ranged from 0.62 to 0.90. As hypothesised, the function scale was correlated with the WOOS “Physical symptoms” subscale. Reliability was adequate according to the ICCs. The ceiling effect threshold for the appearance scale was reached and that for the back scale was almost reached. There were significant differences between patients and controls, in the hypothesised direction. Conclusions The results of this study support a good internal consistency, convergent validity, test–retest reliability and known-group validation for the Swedish BREAST-Q LD questionnaire. However, it may be difficult to discriminate between patients with very mild and those with no symptoms using the appearance scale. Trial registration: ClinicalTrials.Gov identifier NCT04526561.

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“…Of the six identified PROM instruments, only three, BREAST-Q, [19][20][21] BRECON-31 [22][23][24] and EORTC QLQ-BRECON-23 [25][26][27] were considered to have adequate content validity (see below). Of the remainder, the Michigan BR Outcome Study (MBROS) group developed a BRspecific questionnaire item set for satisfaction (MBROS-S) 28 and body image (MBROS-BI), 29 using input from an expert panel alone.…”

Section: Prom Instruments Selection For Full Cosmin Evaluationmentioning

confidence: 99%

Patient-Reported Outcome Measures for Post-mastectomy Breast Reconstruction: A Systematic Review of Development and Measurement Properties

et al. 2020

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Background. Breast reconstruction (BR) is performed to improve outcomes for patients undergoing mastectomy. A recently developed core outcome set for BR includes six patient-reported outcomes that should be measured and reported in all future studies. It is vital that any instrument used to measure these outcomes as part of a core measurement set be robustly developed and validated so data are reliable and accurate. The aim of this systematic review is to evaluate the development and measurement properties of existing BR patient-reported outcome measures (PROMs) to inform instrument selection for future studies. Methods. A PRISMA-compliant systematic review of development and validation studies of BR PROMs was conducted to assess their measurement properties. PROMs with adequate content validity were assessed using three steps: (1) the methodological quality of each identified study was assessed using the COSMIN Risk of Bias checklist; (2) criteria were applied for assessing good measurement properties; and (3) evidence was summarized and the quality of evidence assessed using a modified GRADE approach. Results. Fourteen articles reported the development and measurement properties of six PROMs. Of these, only three (BREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23) were considered to have adequate content validity and proceeded to full evaluation. This showed that all three PROMs had been robustly developed and validated and demonstrated adequate quality. Conclusions. BREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23 have been well-developed and demonstrate adequate measurement properties. Work with key stakeholders is now needed to generate consensus regarding which PROM should be recommended for inclusion in a core measurement set.

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Measuring the patient perspective on latissimus dorsi donor site outcomes following breast reconstruction

Cited by 16 publications

References 13 publications

Thoracodorsal artery flaps for breast reconstruction–the variants and its approach

Thoracodorsal artery flaps for breast reconstruction–the variants and its approach

Validation and reliability testing of the Breast-Q latissimus dorsi questionnaire: cross-cultural adaptation and psychometric properties in a Swedish population

Patient-Reported Outcome Measures for Post-mastectomy Breast Reconstruction: A Systematic Review of Development and Measurement Properties

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