Development of a New Patient-Reported Outcome Measure for Breast Surgery: The BREAST-Q

TLDR

Measuring patient‑reported outcomes has become increasingly important in cosmetic and reconstructive breast surgery. The study aimed to develop a new patient‑reported outcome measure to assess the unique outcomes of breast surgery patients. The authors used patient interviews, focus groups, expert panels, and literature review to create a conceptual framework and questionnaire items, developed three procedure‑specific modules, piloted them with cognitive debriefing, field‑tested them with 1,950 women across five centers, and applied Rasch and traditional psychometric analyses to construct the scales. The resulting BREAST‑Q system, with pre‑ and post‑operative modules for augmentation, reduction, and reconstruction, produced independent scales that met Rasch and traditional psychometric criteria and can be used to evaluate patient satisfaction, quality of life, and surgical effectiveness, thereby supporting advocacy and evidence‑based practice.

Abstract

Measuring patient-reported outcomes has become increasingly important in cosmetic and reconstructive breast surgery. The objective of this study was to develop a new patient-reported outcome measure to assess the unique outcomes of breast surgery patients.Patient interviews, focus groups, expert panels, and a literature review were used to develop a conceptual framework and a list of questionnaire items. Three procedure-specific questionnaires (augmentation, reduction, and reconstruction) were developed and cognitive debriefing interviews used to pilot each questionnaire. Revised questionnaires were field tested with 1950 women at five centers in the United States and Canada (response rate, 72 percent); 491 patients also completed a test-retest questionnaire. Rasch measurement methods were used to construct scales, and traditional psychometric analyses, following currently recommended procedures and criteria, were performed to allow for comparison with existing measures.The conceptual framework included six domains: satisfaction with breasts, overall outcome, and process of care, and psychosocial, physical, and sexual well-being. Independent scales were constructed for these domains. This new patient-reported outcome measure "system" (the BREAST-Q) contains three modules (augmentation, reconstruction, and reduction), each with a preoperative and postoperative version. Each scale fulfilled Rasch and traditional psychometric criteria (including person separation index 0.76 to 0.95; Cronbach's alpha 0.81 to 0.96; and test-retest reproducibility 0.73 to 0.96).The BREAST-Q can be used to study the impact and effectiveness of breast surgery from the patient's perspective. By quantifying satisfaction and important aspects of health-related quality of life, the BREAST-Q has the potential to support advocacy, quality metrics, and an evidence-based approach to surgical practice.