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

Results

One hundred sixty-eight eligible participants who underwent reduction mammaplasty between March of 2010 and February of 2016 completed the BREAST-Q questionnaire preoperatively and 156 completed the questionnaire postoperatively. Of these, 132 participants (76 percent) completed the BREAST-Q Reduction module at both time points. Patient demographics from the surgical cohort are summarized in Table 1. The median patient age was 42 years (range, 18 to 72 years), and the mean ± SD body mass index was 32.1 ± 5.7 kg/m2. The mean total weight of breast tissue resected at surgery was 1298.7 ± 824.7 g. The inferior pedicle was used in the majority (78 percent) of operations, and the superomedial pedicle was used in 19 percent. Forty-five patients (34 percent) experienced a complication (Table 1).

Statistically significant improvements were found across all BREAST-Q scales measured preoperatively and postoperatively—Satisfaction with Breasts, Psychosocial Well-being, Sexual Well-being, and Physical Well-being—when compared to preoperative scores (p < 0.001) (Table 2). Satisfaction with Breasts improved with a mean ± SD change of 51.4 ± 20.3; Psychosocial Well-being improved with a mean ± SD change of 36.9 ± 21.7; Sexual Well-being improved with a mean change of 31.4 ± 25.0; and Physical Well-being improved with a mean change of 32.7 ± 17.9. Change effect size calculations show a very large effect in all BREAST-Q scales when comparing preoperative and postoperative scores (Table 2). Multiple regression analysis was used to determine the participant demographic variables associated with the change in BREAST-Q scores. Figure 1 demonstrates that participants with a higher body mass index of 30 kg/m2 or greater [n = 85 (64 percent)] had a greater mean change in Psychosocial Well-being, Sexual Well-being, and Physical Well-being than those with a body mass index less than 30 kg/m2 [n = 47 (36 percent)]. Participants aged 40 years and older had a greater mean change in Satisfaction with Breasts than those younger than 40 years (Figure 1). Mean change in BREAST-Q scores was not significantly different between patients who had a postoperative surgical complication and those who did not (Table 3).

Figure 1.

Mean change in BREAST-Q scores in surgical participants. Error bars = 95 percent confidence intervals. Orange line, mean score for individual BREAST-Q scales; BMI, body mass index.

Normative BREAST-Q Reduction module data were obtained from female panelists within the Pureprofile Australia organization. Patient demographics from the normative cohort are summarized in Table 4. The median patient age was 45 years (range, 18 to 88 years) and the mean body mass index was 27.8 ± 7.0 kg/m2. The majority of women were nonobese, with a body mass index of less than 30 kg/m2 [n = 356 (69 percent)], and 43 percent of women had a bra size of at least a D cup. The surgical and normative cohorts were comparable with regard to age and obesity status. A chronic health condition was reported by 29 percent of respondents (n = 148). Most women were employed in either a part-time [n = 143 (28 percent)] or full-time basis [n = 119 (23 percent)]. Mean normative BREAST-Q scores are summarized in Table 5.

Normative BREAST-Q scores with relevant covariables across the four scales that constitute the preoperative version are shown in Figure 2. Multiple regression analysis was used to determine the independent demographic variables associated with BREAST-Q scores. Participants with a higher body mass index of 30 kg/m2 or greater and those with a chronic health condition were found to have lower BREAST-Q scores across all scales when compared to respective comparison groups. Participants aged 40 years and older were found to have higher BREAST-Q scores in Satisfaction with Breasts, Psychosocial Well-being and Physical Well-being scales.

Figure 2.

Normative BREAST-Q Reduction module preoperative scores. Error bars = 95 percent confidence intervals. Orange line, mean score for individual BREAST-Q scales; BMI, body mass index.

BREAST-Q norms generated in this study were compared to scores from patients in the surgical cohort with symptomatic breast hypertrophy who proceeded to reduction mammaplasty. Figure 3 demonstrates mean BREAST-Q scores for surgical patients before and 12 months after surgery in comparison to norms for Australia and the United States. In comparison to normative values, women with breast hypertrophy who were awaiting surgery had significantly lower BREAST-Q scores preoperatively across all scales. Postoperatively, mean scores improved significantly to levels at least that of the normative Australian population. Mean BREAST-Q scores from "satisfaction" scales that are captured in the postoperative version are presented in Figure 4. Results of the Pearson correlation indicated that there was a strong, positive association between Satisfaction with Outcome and Satisfaction with Breasts (r = 0.7; p < 0.001), Satisfaction with Surgeon (r = 0.7; p < 0.001), and Satisfaction with Information (r = 0.6; p < 0.001) (Table 6). Weak positive correlations were observed between Satisfaction with Outcome and the remaining BREAST-Q scales.

Figure 3.

Comparison of surgical patient group mean BREAST-Q scores before and after reduction surgery to normative scores for Australia and the United States. Error bars = 95 percent confidence intervals.

Figure 4.

Postoperative only BREAST-Q Reduction module satisfaction scale scores. Error bars = 95 percent confidence intervals.

When considering 12-month outcomes, no differences in Satisfaction with Outcome BREAST-Q scores were found between patients who experienced a complication (mean ± SD, 85.1 ± 16.6) and those who did not (mean ± SD, 87.6 ± 18.0). Participants aged 40 years and older (mean ± SD, 90.0 ± 13.6) had significantly higher Satisfaction with Outcome than younger participants (mean ± SD, 82.5 ± 21.3; p = 0.015). Patients with a higher body mass index of 30 kg/m2 or greater were found to have significantly higher outcome scores (Table 7). Scores were not significantly different between participants who met traditional insurance criteria requirements (Schnur sliding scale and the 500-g minimum rule) and those who did not (Table 7).

Table 8 shows the comparison of Australian normative data generated by this study to previously published United States norms. When comparing the 95 percent confidence intervals, the results showed that the Australian mean scores across all four preoperative BREAST-Q scales were significantly lower than U.S. norms, in particular for the Psychosocial Well-being scale (Table 8).

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