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Establishing Institution-specific Normative Data for the BREAST-Q Reconstruction Module: A Prospective Study

Klifto, Kevin M. PharmD; Aravind, Pathik MBBS; Major, Melissa BS, BBA; Payne, Rachael M. MD; Shen, Wen MD, MPH; Rosson, Gedge D. MD; Cooney, Carisa M. MPH; Ann Manahan, Michele MD, MBA

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 31-32
doi: 10.1097/01.GOX.0000584372.31145.8a
Breast Abstracts

Johns Hopkins University, Baltimore, MD

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: The BREAST-Q has been used extensively to assess patient-reported breast surgery outcomes; however, breast satisfaction in a general female population is relatively unknown, and prior research in the army of women (AoW) did not reflect the general US population or our community.1 We sought to assess breast satisfaction in a cohort of female participants more representative of the general US population and of our patient population at Johns Hopkins (JH).

METHODS: This is a single-center, cross-sectional, patient-reported outcomes study. A preoperative BREAST-Q reconstruction module and demographic form were administered to 300 female participants who presented for gynecology appointments (JH population). Eligible patients were women with no history of breast cancer or breast surgery and were not pregnant. We assessed participant-related factors capable of influencing BREAST-Q scores using linear multivariate regression analysis and compared JH population demographics to the AoW study population and the US Census Bureau data using the independent t test and Pearson’s chi-square test. JH population mean BREAST-Q scores were compared to AoW using the minimal important difference (MID) to establish clinical significance.2,3

RESULTS: Increasing body mass index had a significant association with lower Satisfaction with Breast and lower Psychosocial Well-being scores. Increasing participant age was associated with significantly lower Sexual Well-being scores. African American participants had significantly higher scores for Satisfaction with Breasts, Psychosocial Well-being, and Sexual Well-being compared to white participants. Participants with bra cup sizes A, B, C, and DD had significantly higher Sexual Well-being scores than sizes less than A; bra cup sizes A, B, and C were associated with significantly higher Physical Well-being Chest scores than sizes less than A. Study participants reported lower Physical Well-being Chest scores, but higher Physical Well-being Abdomen scores than the AoW members. After comparing MID, Physical Well-being Chest scores were clinically significantly lower in our study participants compared to AoW members (MID >1). All other BREAST-Q domains had a MID <1.

CONCLUSIONS: We found associations between BREAST-Q scores and body mass index, age, race, and bra cup size in our population. Our populations Physical Well-being Chest scores were lower than AoW normative data. Determining normative BREAST-Q scores in a representative population of women could serve as an important baseline for breast outcomes research.


1. Mundy LR, Homa K, Klassen AF, et al. Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Reconstr Surg. 2017;139:1046e–1055e.

2. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41:582–592.

3. Cano SJ, Klassen AF, Scott A, et al. Interpreting clinical differences in BREAST-Q scores: minimal important difference. Plast Reconstr Surg. 2014;134:173e–175e.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.