A five year experience of measuring clinical effectiveness in a breast reconstruction service using the BREAST-Q patient reported outcomes measure: A cohort study

Objective: To assess the clinical effectiveness of breast reconstruction and the utility of the BREAST-Q patient-reported outcomes measure for routine patient care. Methods: The BREAST-Q was administered to all patients attending a breast reconstructive service (n = 343) at a University Hospital at each visit. Results: The BREAST-Q was easy to administer in a clinic setting, with a high participation rate (64.2% completing the minimum dataset of three BREAST-Qs). Pre-operatively, women with invasive cancer scored lower than those with DCIS or high-risk status (eg. mean psychosocial well-being scores 51.45 vs 63.74 vs 65.56, p < 0.05). At six months post-mound reconstruction the mean values for immediate and delayed timing of reconstruction were similar, with the change in quality of life from pre-reconstruction to this time-point post-reconstruction being greater in the delayed group (eg. mean improvement in psychosocial well-being scores for immediate 8.90 vs delayed 19.87, p < 0.05). Women with autologous flaps had greater improvements than women with implant-based reconstruction (eg. mean increase in psychosocial wellbeing scores 20.29 vs 9.58, p < 0.05). Breast reconstruction was highly effective in terms of improving psychosocial (mean pre-op 55.44 vs post-op 71.47, p < 0.001), physical (mean pre-op 69.82 vs post-op 74.78, p < 0.001), and sexual well-being (mean pre-op 38.74 vs post-op 54.17, p < 0.001), as well as satisfaction with breasts (mean pre-op 44.99 vs postop 64.92, p < 0.001), in this non-selected cohort of patients. Conclusion: Breast reconstruction is highly effective in improving the well-being of women undergoing mastectomy. The BREAST-Q is well suited for clinical effectiveness research and easily incorporated into routine patient care. Crown Copyright (C) 2016 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.