Outcomes of Breast Reduction Surgery Using the BREAST-Q

A Prospective Study and Comparison With Normative Data

Tamara A. Crittenden, B.Sc.(Hons.); David I. Watson, M.D., Ph.D.; Julie Ratcliffe, Ph.D., M.Sc.; Philip A. Griffin, M.B.B.S.; Nicola R. Dean, M.B.Ch.B., Ph.D.

Disclosures

Plast Reconstr Surg. 2019;144(5):1034-1044. 

In This Article

Abstract and Introduction

Abstract

Background: This study aimed to assess breast-related satisfaction and well-being in women with breast hypertrophy before and after breast reduction surgery, and to compare these scores with Australian general population norms, using the BREAST-Q Reduction module.

Methods: A prospective cohort study was conducted between March of 2010 and February of 2016. Participants self-completed the BREAST-Q preoperatively and 12 months postoperatively. Normative BREAST-Q data were generated from women aged 18 years and older for comparison. Statistical analysis was performed and values of p < 0.05 were considered significant.

Results: The BREAST-Q was completed by 132 participants preoperatively and 12 months postoperatively. Statistically significant improvements were found following surgery in Satisfaction with Breasts, Psychosocial Well-being, Sexual Well-being, and Physical Well-being. In comparison with normative data, patients with breast hypertrophy had significantly lower scores preoperatively, with scores significantly increasing postoperatively to levels representative of the general population. Satisfaction with outcome was not significantly different between patients who were eligible by traditional insurance requirements (Schnur sliding scale/500-g minimum rule) and those who were not. The presence of surgical complications did not affect change in BREAST-Q scores or postoperative satisfaction with outcome. Differences were observed in mean BREAST-Q scores when comparing generated Australian norms to published U.S. norms.

Conclusions: Breast reduction surgery significantly improves the satisfaction and quality of life in women with breast hypertrophy to a level that is at least equivalent to that of the normative population. Surgery is of benefit to all women, including those who do not meet traditional insurance requirements.

Clinical Question/Level of Evidence: Therapeutic, IV.

Introduction

Breast hypertrophy has a significant impact on quality of life in affected women. Breast reduction surgery has been proven to not only reduce pain and functional problems, but to significantly improve health-related quality of life to levels comparable to those of the general population.[1–6] Despite evidence that surgery is the most effective treatment for breast hypertrophy,[7,8] in an era of limited health budgets and increased demand for surgery, health care funders and third-party providers have placed arbitrary restrictions on access to surgery in many jurisdictions worldwide.[4,5,9–13] Many providers commonly determine the medical necessity for reduction mammaplasty using the Schnur sliding scale based on body surface area–adjusted minimum resection weight calculations; this is a scale that was never intended for this purpose and has since been misused.[11,14,15]

The BREAST-Q is a condition-specific patient-reported outcome measure that was developed and validated by Pusic and colleagues to assess patient satisfaction and health-related quality of life following cosmetic, functional, and reconstructive breast surgery.[16] Most reported studies using the BREAST-Q Reduction module to assess outcomes following breast reduction surgery have been limited by their retrospective design, and lack of comparison of scores with a preoperative baseline.[17–22] The availability of normative BREAST-Q data has provided a valuable reference point as to the levels of breast-related satisfaction and quality of life within the general population, enabling a better understanding of the health deficit of breast hypertrophy and the success of breast reduction surgery.[3] However, normative BREAST-Q data are currently limited to the U.S. population, and evidence has shown that there are potentially important differences between populations when comparing health-related quality of life.[23–25]

To the authors' knowledge, this is the largest prospective study using the BREAST-Q to assess outcomes following breast reduction surgery. The primary objective was to assess breast-related satisfaction and health-related quality of life in women with breast hypertrophy before and after breast reduction surgery. Secondary objectives were to generate normative data for the BREAST-Q Reduction module from an Australian population; compare generated norms with women with breast hypertrophy who proceeded to reduction mammaplasty; and compare the data to previously published United States norms.

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