Systematic Review of Breast-Q: A Tool to Evaluate Post-Mastectomy Breast Reconstruction

Purpose: The aim of this systematic review is to update and synthesize new evidence on BREAST-Q questionnaire's ability to reflect patient-reported outcomes in women who have undergone breast reconstruction surgery (BRS) following mastectomy. Methods: PubMed, Science Direct, Google Scholar, Cochrane CENTRAL, and Clincaltrial. gov were searched for relevant studies from January 2009 to September 2021. Any inter-ventional or observational studies that used BREAST-Q to assess patient-reported outcomes in the assessment of BRS following mastectomy were included. Results: A total of 42 studies were eligible for inclusion in the review. Three were randomized controlled trials and 39 were observational studies. Compared with pre-operative scores, there was an improvement in all BREAST-Q outcome domains following BRS including 'satisfaction with breasts', "satisfaction with outcome" "psychosocial", "physical", and "sexual wellbeing". Sexual well-being had the lowest BREAST-Q score both pre-and post-operatively (37.8-80.0 and 39.0- 78.0, respectively). Autologous BRS reports higher satisfaction and overall wellbeing compared to implant-based BRS. BREAST-Q has a higher and narrow internal consistency of 0.81 to 0.96 compared with other patient-reported outcome measures (PROMs; EORTC-QLQ, FACT-B, BR -23, BCTOS). The BREAST-Q questionnaire is the only PROM which allows patients to reflect on their care, surgical outcomes, and satisfaction collectively. Conclusion: This review highlights the fact that BREAST-Q can effectively and reliably measure satisfaction and wellbeing of breast cancer patients after BRS. Comparatively, sexual wellbeing shows poorer outcomes following BRS and more longitudinal studies are necessary to understand the basis for these findings. Compared to other PROMs, BREAST-Q is reliable and specific to breast cancer surgery. Overall, BREAST-Q can help clinicians improve their quality of service, understand patient experiences, and may be used as an auditing tool for surgical outcomes.