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.


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

In This Article

Patients and Methods

Surgical Study Population

A prospective cohort study of patients who underwent breast reduction surgery was performed at Flinders Medical Centre in Adelaide, South Australia, Australia. Ethics approval was obtained for this project from the local Southern Adelaide Clinical Human Research Ethics Committee (approval number 118.056). All women aged 18 years and older with symptomatic breast hypertrophy who were eligible for bilateral breast reduction surgery between March of 2010 and February of 2016 were informed of the study and were considered for inclusion. Women who were unable to complete written questionnaires or refused to participate, were excluded from the study. Participants provided written informed consent and self-completed the BREAST-Q Reduction module patient-reported outcome measure preoperatively and 12 months postoperatively. Age, height, weight, and smoking status were recorded at the time of enrollment. Intraoperatively, the surgical technique and weight of tissue resected from each breast was documented. Postoperatively, a comprehensive "complications assessment checklist" was completed by the surgeon.

Normative Study Participant Recruitment

Australian women aged 18 years and older who were registered members of Pureprofile Limited (Sydney, New South Wales, Australia), a global online survey company, were invited to participate in the study. Consenting respondents who self-reported as being without a history of breast cancer or breast surgery and not actively seeking breast surgery were eligible to participate in this part of the study. Participants were required to self-complete the preoperative version of the BREAST-Q Reduction module and provide information for the following relevant variables: age, body mass index, bra cup size, employment status, and health status. Participants within the normative study cohort were distributed across age and geographic variables in a manner consistent with the national representation population breakdown from the 2016 Census conducted by the Australian Bureau of Statistics.[26] Ethics approval was obtained for this part of the study from the Social and Behavioural Research Ethics Committee at Flinders University (approval number 7848).

BREAST-Q Outcome Measure

The BREAST-Q Reduction module was used to evaluate breast-related satisfaction and health-related quality of life in women with breast hypertrophy who underwent breast reduction surgery, and in women within the general population.[16] The instrument comprises Likert-type item responses across independently functioning patient satisfaction and well-being scales. The preoperative version of the BREAST-Q comprises the following scales: Satisfaction with Breasts, Psychosocial Well-being, Sexual Well-being, and Physical Well-being. In addition, the postoperative version includes Satisfaction with Outcome, Satisfaction with Information, Satisfaction with Surgeon, Satisfaction with Medical Staff, and Satisfaction with Office Staff. Questionnaire responses were transformed using Q-Score software[27] to generate a score between 0 and 100, where a score of 0 is the minimum score and 100 is the maximum score and indicates the highest level of satisfaction or well-being.

Statistical Analysis

Statistical analyses were performed using IBM SPSS Version 25.0 statistical software (IBM Corp., Armonk, N.Y.). Descriptive statistics including mean, standard deviation, and 95 percent confidence interval were computed for continuous variables. To assess the significance of changes in health-related quality of life, mean BREAST-Q scores obtained preoperatively and 12 months postoperatively were compared using a paired t test for dependent samples. Change effect size statistics were computed as the mean difference between preoperative and postoperative BREAST-Q scores divided by the standard deviation of the baseline score. Change effect sizes were interpreted according to the thresholds established by Cohen (i.e., <0.20, trivial; 0.20 to 0.50, small; >0.50 to 0.80, moderate; and >0.80, large).[28] BREAST-Q scores from the surgical cohort were compared to Australian population normative data using an independent t test. The Pearson correlation coefficient was used to investigate the strength of association between two continuous variables. Multiple regression analysis was used to explore the relationship between BREAST-Q scores and independent demographic variables. Statistical significance was established at a value of p < 0.05. The authors adhered to the Strengthening the Reporting of Observational Studies in Epidemiology Statement and checklist when designing and reporting this study.[29]