We read with great interest the article entitled “A Comparison of Psychological Response, Body Image, Sexuality, and Quality of Life between Immediate and Delayed Autologous Tissue Breast Reconstruction: A Prospective Long-Term Outcome Study” by Zhong et al.1 We agree that, in patients who are oncologically eligible and strongly interested in breast reconstruction, efforts should be made to provide immediate breast reconstruction to decrease the interval of psychosocial distress, poor body image, and impaired sexuality.
Body image is a key element of sexual identity; it is structured in biological, psychosexual, and relationship aspects, and it must be understood as gender identity, which is the intrapsychic representation that each of us has. In addition to sexual identity, body image can also modulate the other two pillars of sexuality (i.e., sexual function and sexual relationship) through the complex physical and emotional interactions that occur during intercourse. The concept of body image integrates multisensory perception that we have of ourselves from emotional, cognitive, and sexual points of view. Focusing our attention on female sexuality, we find that in this complex and fascinating picture, a special role is played by the breast and its peculiar erotic meaning. The appearance and the beauty of the breast are indeed of the utmost importance to the sense of femininity, self-esteem, self-confidence, and erotic sensitivity of the woman.
The BREAST-Q,2 published in 2009, is a rigorously developed, validated, breast surgery–specific patient-reported outcomes instrument that has been used in research with over 22,000 women having different types of breast surgery. Development of the BREAST-Q conceptual framework and set of scales involved a literature review, 48 patient interviews, 46 cognitive patient interviews, and expert opinion from a panel of plastic surgeons and other health care professionals. The scales were then tested in a sample of 2715 patients, with a response rate of 72 percent. We used this patient-reported outcomes in our clinical practice, and this is the only instrument that analyzes functional, psychosocial, and sexual aspects of patients following breast surgery. We applied it in cosmetic and reconstructive breast procedures. Achieving patient satisfaction and improving or maintaining health-related quality of life are important outcomes of breast reconstruction surgery; patients require more attention in presurgical consultations, and clear communication should be prioritized to ensure that the surgeon understands the patient’s expectations.3 The assessment of quality of life before and after surgery cannot be based on personal considerations of the attending physician, but must necessarily be expressed through objective studies, such as evaluation by means of the BREAST-Q.4 The operation should be chosen not only based on the anatomical part to be rebuilt but also according to what the patient expects. We applied the BREAST-Q Reconstruction module on a large sample of women following mastectomy with or without breast reconstruction and we could confirm that, functionally and aesthetically, patients with breast reconstruction are more satisfied. We hope to publish our results as soon as possible.
The authors have no commercial associations that might pose or create a conflict of interest with information presented in this communication. No intramural or extramural funding supported any aspect of this work.
Mauro Barone, M.D.
Annalisa Cogliandro, M.D., Ph.D.
Paolo Persichetti, M.D., Ph.D.
Plastic and Reconstructive Surgery Unit
Campus Bio-Medico University
1. Zhong T, Hu J, Bagher S, et alA comparison of psychological response, body image, sexuality, and quality of life between immediate and delayed autologous tissue breast reconstruction: A prospective long-term outcome study. Plast Reconstr Surg. 2016;138:772–780.
2. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJDevelopment of a new patient-reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg. 2009;124:345–353.
3. Barone M, Cogliandro A, La Monaca G, Tambone V, Persichetti PCognitive investigation study of patients admitted for cosmetic surgery: Information, expectations, and consent for treatment. Arch Plast Surg. 2015;42:46–51.
4. Cagli B, Cogliandro A, Barone M, Persichetti PQuality-of-life outcomes between mastectomy alone and breast reconstruction: Comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2014;133:594e–595e.
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