Systematic Review of Breast-Q: A Tool to Evaluate Post-Mastectomy Breast Reconstruction

Abstract

Purpose The aim of this systematic review is to update and synthesize new evidence on BREAST-Q questionnaire’s ability to reflect patient-reported outcomes in women who have undergone breast reconstruction surgery (BRS) following mastectomy. Methods PubMed, Science Direct, Google Scholar, Cochrane CENTRAL, and Clincaltrial.gov were searched for relevant studies from January 2009 to September 2021. Any interventional or observational studies that used BREAST-Q to assess patient-reported outcomes in the assessment of BRS following mastectomy were included. Results A total of 42 studies were eligible for inclusion in the review. Three were randomized controlled trials and 39 were observational studies. Compared with pre-operative scores, there was an improvement in all BREAST-Q outcome domains following BRS including ‘satisfaction with breasts’, “satisfaction with outcome” “psychosocial”, “physical”, and “sexual wellbeing”. Sexual well-being had the lowest BREAST-Q score both pre-and post-operatively (37.8–80.0 and 39.0–78.0, respectively). Autologous BRS reports higher satisfaction and overall wellbeing compared to implant-based BRS. BREAST-Q has a higher and narrow internal consistency of 0.81 to 0.96 compared with other patient-reported outcome measures (PROMs; EORTC-QLQ, FACT-B, BR-23, BCTOS). The BREAST-Q questionnaire is the only PROM which allows patients to reflect on their care, surgical outcomes, and satisfaction collectively. Conclusion This review highlights the fact that BREAST-Q can effectively and reliably measure satisfaction and wellbeing of breast cancer patients after BRS. Comparatively, sexual wellbeing shows poorer outcomes following BRS and more longitudinal studies are necessary to understand the basis for these findings. Compared to other PROMs, BREAST-Q is reliable and specific to breast cancer surgery. Overall, BREAST-Q can help clinicians improve their quality of service, understand patient experiences, and may be used as an auditing tool for surgical outcomes.

Psychosocial and sexual well‐being in breast cancer survivors undergoing immediate breast reconstruction: The mediating role of breast satisfaction

“…In this way, our findings are consistent with studies indicating that patients undergoing IR increase their quality of life levels compared to those who have not been reconstructed, regardless of the reason and type of surgery (Beugels et al, 2018;Fanakidou et al, 2018;Howes et al, 2016;van Bommel et al, 2020). Besides, these results are consistent with studies concluding that quality of life scores are similar in groups of women with one-stage and two-stage breast reconstruction (Meshulam-Derazon et al, 2018;Seth et al, 2021); one-stage and two-stage breast reconstruction using tissue expanders (Qureshi et al, 2017); one-stage reconstruction with acellular dermal matrices versus conventional two-stage expander or implant use (Negenborn et al, 2018;Srinivasa et al, 2017); and IR with prosthesis and acellular dermal matrix versus two-stage submuscular approach (Caputo et al, 2021).…”

“…Regarding the type of technique used in breast reconstruction, Meshulam‐Derazon et al ( 2018 ) and Seth et al ( 2021 ) concluded that there are no significant differences in levels of quality of life between women who underwent one‐stage and two‐stage breast reconstruction, except for satisfaction with information. However, Meshulam‐Derazon et al ( 2018 ) report higher scores in sexual well‐being in women with more background diseases; higher levels of psychosocial well‐being in married women; lower values in breast satisfaction in women treated with radiation and higher values among patients with bilateral reconstruction, with the latter subgroup also showing higher physical well‐being.…”

Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study

“…Multiple modules are applicable to various surgical methods. It is widely used by breast surgeons all over the world to assess patients' health-related quality of life [29,30].…”

Does breast oncoplastic surgery improve quality of life?

“…In the first version, questionnaires related to augmentation mammoplasty, reduction mammoplasty and reconstruction were created ( 48 ). Currently, the Breast-Q is in its the second edition and is the most popular questionnaire for breast reconstruction ( 49 , 50 ). Regarding the Breast-Q, the main domains related to cancer modules are summarized in Table 2 .…”