Plastic & Reconstructive Surgery:
Pusic, Andrea L. M.D., M.H.S.; Klassen, Anne F. D.Phil.; Cano, Stefan J. Ph.D.
Memorial Sloan-Kettering Cancer Center, New York, N.Y. (Pusic)
McMaster University, Hamilton, Ontario, Canada (Klassen)
Peninsula College of Medicine and Dentistry, Plymouth, United Kingdom (Cano)
Correspondence to Dr. Pusic, Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, Room MRI-1007, 1275 York Avenue, New York, N.Y. 10065 email@example.com
We wrote this Letter to the Editor regarding the article by Patel et al.1 For patients undergoing oncoplastic breast surgery, quality of life and satisfaction with breast appearance are key considerations. Dr. Patel et al. should thus be congratulated on their cross-sectional evaluation of these important patient-reported outcomes. We were very pleased to see that the authors selected the BREAST-Q2 as the primary outcome measure for their study. With grant support from the Plastic Surgery Foundation, the BREAST-Q was developed and validated over a 5-year period with the aid of approximately 3000 women. The BREAST-Q is a psychometrically sound and clinically meaningful patient-reported outcome measure with a state-of-the-art scoring system. Based on the article by Patel et al., we would like to raise and clarify two critical issues about the use of the BREAST-Q by the clinical research community.
Figure. No caption a...Image Tools
The first issue relates to appropriate use of the BREAST-Q. The BREAST-Q is composed of multiple, independently functioning scales (e.g., Satisfaction with Breasts, Psychosocial Well-Being, Sexual Well-Being). In any given study, it is not necessary to use all the scales. Rather, given that each scale was designed to measure a unidimensional construct, investigators are able to pick and choose which scales they deem to be the most relevant to answering their study's research question(s). Scale selection per se does not constitute an “adaptation” of the BREAST-Q (this was erroneously suggested by Patel et al.). Conversely, any changes made to the content of the BREAST-Q (e.g., changing the wording of individual questionnaire items, or adding new items to any of its validated scales) is not acceptable. The problem with changing previously developed and psychometrically validated scales is that such changes nullify the psychometric properties of the questionnaire. Furthermore, using an adapted measure makes it impossible to compare findings with those of other BREAST-Q studies. Importantly, such adaptations are prohibited under copyright laws.
The second issue relates to appropriate scoring of the BREAST-Q. It is crucial that raw responses provided by patients be transformed into BREAST-Q scores using the Q-Score program. This program is provided free of charge on our Web site (www.BREAST-Q.org). Using this program, researchers are able to convert their raw questionnaire data and then compute summary scores for each BREAST-Q scale that range from 0 to 100 (with a higher number indicating higher satisfaction or better quality of life). The transformation is essential, as it is through this process that the ordinal-level data are linearized by means of item calibrations.2 Using Q-Score, researchers may then compare their sample of patients with patients from different studies on the same metrics. As Dr. Patel et al. did not use the Q-Score program to score their study data, it is impossible to interpret their findings or compare their findings with other BREAST-Q–based research.
It is exciting to see a growing number of clinical researchers using patient-reported outcome measures such as the BREAST-Q in their studies and working to better understand the impact of plastic surgery from a patient perspective. Our team recommends that users of the BREAST-Q adhere to our published guidelines about the appropriate use and scoring of this measure. Doing so will ensure that the accumulation of BREAST-Q data by the research community can be brought together to inform further clinical interpretation of BREAST-Q data scores.
Andrea L. Pusic, M.D., M.H.S.
Memorial Sloan-Kettering Cancer Center, New York, N.Y.
Anne F. Klassen, D.Phil.
McMaster University, Hamilton, Ontario, Canada
Stefan J. Cano, Ph.D.
Peninsula College of Medicine and Dentistry, Plymouth, United Kingdom
The BREAST-Q is owned by Memorial Sloan-Kettering Cancer Center and the University of British Columbia. Drs. Pusic, Klassen, and Cano are co-developers of the BREAST-Q and receive a share of licensing revenues based on the inventor-sharing policies of these two institutions.
1. Patel KM, Hannan CM, Gatti ME, Nahabedian MY. A head-to-head comparison of quality of life and aesthetic outcomes following immediate, staged-immediate, and delayed oncoplastic reduction mammaplasty. Plast Reconstr Surg. 2011;127:2167–2175.
2. Pusic A, Klassen A, Scott A, Klok J, Cordeiro P, Cano S. Development of a new patient reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg. 2009;124:345–353.
Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.
Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.
Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/.
We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.
The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.