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Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q

Mundy, Lily R. M.D.; Homa, Karen Ph.D.; Klassen, Anne F. D.Phil.; Pusic, Andrea L. M.D.; Kerrigan, Carolyn L. M.D., M.H.C.D.S.

Plastic and Reconstructive Surgery: May 2017 - Volume 139 - Issue 5 - p 1046e-1055e
doi: 10.1097/PRS.0000000000003241
Breast: Outcomes Articles

Background: The BREAST-Q is a patient-reported outcome instrument used to evaluate outcomes in patients undergoing breast cancer surgery and reconstruction. Normative values for the BREAST-Q breast cancer modules have not been established, limiting data interpretation.

Methods: Participants were recruited by means of the Army of Women, an online community of women (with and without breast cancer), to complete Mastectomy, Breast Conserving Therapy, and Reconstruction preoperative BREAST-Q scales. Inclusion criteria were women aged 18 years or older without a history of breast surgery or breast cancer. Analysis included descriptive statistics, a linear multivariate regression, and a comparison of the generated normative data to previously published BREAST-Q findings.

Results: The BREAST-Q was completed by 1201 women. The mean patient age was 54 ± 13 years, mean body mass index 26 ± 6 kg/m2, and 38 percent (n = 455) had a bra cup size of D or greater. Mean ± SD scores for BREAST-Q scales were as follows: Satisfaction with Breasts (58 ± 18), Psychosocial Well-being (71 ± 18), Sexual Well-being (56 ± 18), Physical Well-being-Chest (93 ± 11), and Physical Well-being Abdomen (78 ± 20). Women with a body mass index of 30 kg/m2 or greater, cup size of D or greater, age younger than 40 years, and annual income less than $40,000 reported lower scores. Comparing normative scores to published data in breast cancer patients, Satisfaction with Breasts scores were higher after autologous reconstruction and lower after mastectomy; Sexual Well-being scores were lower after mastectomy and breast conserving therapy; and Physical Well-being Chest scores were lower after mastectomy, breast conserving therapy, and reconstruction.

Conclusion: These are the first published normative scores for the BREAST-Q breast cancer modules and provide a clinical reference point for the interpretation of data.

Durham, N.C.; Lebanon, N.H.; Hamilton, Ontario, Canada; and New York, N.Y.

From the Division of Plastic and Reconstructive Surgery, Duke University; the Section of Plastic Surgery, Dartmouth Hitchcock Medical Center; McMaster University; and the Plastic and Reconstructive Service, Memorial Sloan Kettering Cancer Center.

Received for publication September 22, 2016; accepted November 4, 2016.

Disclosure:Funding for the study was provided from a discretionary account of Dr. Kerrigan’s held by The Dartmouth Institute. The BREAST-Q is owned by Memorial Sloan-Kettering Cancer Center. Dr. Pusic and Dr. Klassen are co-developers. They receive a portion of licensing fees when the BREAST-Q is used in industry sponsored clinical trials. Dr. Pusic received support through the NIH/NCI Cancer Center Support Grant P30 CA008748. Drs. Mundy, Homa, and Kerrigan have no commercial associations or financial disclosures.

Carolyn L. Kerrigan, M.D., M.H.C.D.S., The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, N.H. 03756,

Copyright © 2017 by the American Society of Plastic Surgeons