Share this article on:

BREAST-Q following Breast Reconstruction: Analysis of Breast Perception and Sexuality

Barone, Mauro M.D.; Cogliandro, Annalisa M.D., Ph.D.; Persichetti, Paolo M.D., Ph.D.

Plastic and Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 1016e–1017e
doi: 10.1097/PRS.0000000000003219

Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University, Rome, Italy

Correspondence to Dr. Barone, Via Alvaro Del Portillo 200, Rome, Italy,

Back to Top | Article Outline


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.

Back to Top | Article Outline


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

Rome, Italy

Back to Top | Article Outline


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.
Back to Top | Article Outline


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

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.

©2017American Society of Plastic Surgeons