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BREAST-Q REACT: Clinical Reference Values for the BREAST-Q in Post-mastectomy Breast Reconstruction Patients

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript



The BREAST-Q is the most commonly used patient-reported outcome measure (PROM) for breast reconstruction research. However, clinical implementation of this PROM has been impeded by a lack of context for score interpretation. The aim of this study was to define reference values for the BREAST-Q at discrete timepoints following surgery, generating a tool for real-time score interpretation.


BREAST-Q scores were prospectively obtained in women who underwent implant or autologous post-mastectomy breast reconstruction preoperatively and for 2 years following surgery at Memorial Sloan Kettering Cancer Center (MSK). Descriptive statistics were used to create reference values for BREAST-Q satisfaction and quality-of-life subscales. Reference values were externally validated by comparing patient characteristics and BREAST-Q scores between the MSK and the Mastectomy Reconstruction Outcomes Consortium (MROC) study cohorts.


Overall, 3268 MSK patients and 2814 MROC patients were included for analysis. When MSK and MROC cohorts were compared for validation, there were some statistical differences in BREAST-Q scores; however, most of these differences did not meet the minimal clinically important difference of 4 points. Reference values were used to create the BREAST-Q Real-time Engagement and Communication Tool (REACT).


Using a large cohort of patients, we have defined BREAST-Q reference values for post-mastectomy breast reconstruction patients for use in clinical practice. The BREAST-Q REACT will help breast reconstruction providers gauge patient wellbeing and satisfaction relative to the “average” breast reconstruction patient and determine which patients may benefit from additional intervention.

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  1. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124(2):345–53.

    Article  CAS  Google Scholar 

  2. Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL. The BREAST-Q: further validation in independent clinical samples. Plast Reconstr Surg. 2012;129(2):293–302.

    Article  CAS  Google Scholar 

  3. Fuzesi S, Cano SJ, Klassen AF, Atisha D, Pusic AL. Validation of the electronic version of the BREAST-Q in the army of women study. Breast. 2017;33:44–9.

    Article  Google Scholar 

  4. Nelson JA, Allen RJ Jr, Polanco T, et al. Long-term patient-reported outcomes following postmastectomy breast reconstruction: an 8-year examination of 3268 patients. Ann Surg. 2019;270(3):473–83.

    Article  Google Scholar 

  5. Nelson JA, Sobti N, Patel A, et al. The impact of obesity on patient-reported outcomes following autologous breast reconstruction. Ann Surg Oncol. 2020;27(6):1877–88.

    Article  Google Scholar 

  6. Coriddi M, Shenaq D, Kenworthy E, et al. Autologous breast reconstruction after failed implant-based reconstruction: evaluation of surgical and patient-reported outcomes and quality of life. Plast Reconstr Surg. 2019;143(2):373–9.

    Article  CAS  Google Scholar 

  7. Razdan SN, Cordeiro PG, Albornoz CR, et al. Cost-effectiveness analysis of breast reconstruction options in the setting of postmastectomy radiotherapy using the BREAST-Q. Plast Reconstr Surg. 2016;137(3):510e-e517.

    Article  CAS  Google Scholar 

  8. U. S. Food and Drug Administration. Medical Device Development Tools. 10/20/2020 2020. (accessed 10/30/2020).

  9. Cohen WA, Mundy LR, Ballard TN, et al. The BREAST-Q in surgical research: a review of the literature 2009–2015. J Plast Reconstr Aesthet Surg. 2016;69(2):149–62.

    Article  Google Scholar 

  10. Santosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Long-term patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg. 2018;153(10):891–9.

    Article  Google Scholar 

  11. Pusic AL, Matros E, Fine N, et al. Patient-reported outcomes 1 year after immediate breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol. 2017;35(22):2499–506.

    Article  Google Scholar 

  12. Shi Q, Mendoza TR, Cleeland CS. Interpreting patient-reported outcome scores for clinical research and practice: definition, determination, and application of cutpoints. Med Care 2019; 57 Suppl 5 Suppl 1: S8-S12.

  13. Reeve BB, Wyrwich KW, Wu AW, et al. ISOQOL recommends minimum standards for patient-reported outcome measures used in patient-centered outcomes and comparative effectiveness research. Qual Life Res. 2013;22(8):1889–905.

    Article  Google Scholar 

  14. Schunemann HJ, Akl EA, Guyatt GH. Interpreting the results of patient reported outcome measures in clinical trials: the clinician’s perspective. Health Qual Life Outcomes. 2006;4:62.

    Article  Google Scholar 

  15. Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Reconstr Surg. 2017;139(5):1046e-e1055.

    Article  CAS  Google Scholar 

  16. Klifto KM, Aravind P, Major M, et al. Differences between breast cancer reconstruction and institutionally established normative data using the BREAST-Q reconstruction module: a comparative study. Plast Reconstr Surg. 2020;145(6):1371–9.

    Article  CAS  Google Scholar 

  17. Wilkins EG. Mastectomy Reconstruction Outcomes Consortium (MROC) Study (NCT01723423). July 13, 2017 2012. (accessed 10/30/2020).

  18. Gandek B, Ware JE, Jr. Methods for validating and norming translations of health status questionnaires: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol 1998; 51(11): 953-9.

  19. Voineskos SH, Klassen AF, Cano SJ, Pusic AL, Gibbons CJ. Giving meaning to differences in BREAST-Q scores: minimal important difference for breast reconstruction patients. Plast Reconstr Surg. 2020;145(1):11e–20e.

    Article  CAS  Google Scholar 

  20. Hancock SL, Ryan OF, Marion V, et al. Feedback of patient-reported outcomes to healthcare professionals for comparing health service performance: a scoping review. BMJ Open 2020; 10(11): e038190.

  21. Ovretveit J, Zubkoff L, Nelson EC, Frampton S, Knudsen JL, Zimlichman E. Using patient-reported outcome measurement to improve patient care. Int J Qual Health Care. 2017;29(6):874–9.

    Article  Google Scholar 

  22. Boyce MB, Browne JP, Greenhalgh J. The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research. BMJ Qual Saf. 2014;23(6):508–18.

    Article  Google Scholar 

  23. Rivera SC, Kyte DG, Aiyegbusi OL, Slade AL, McMullan C, Calvert MJ. The impact of patient-reported outcome (PRO) data from clinical trials: a systematic review and critical analysis. Health Qual Life Outcomes. 2019;17(1):156.

    Article  Google Scholar 

  24. Holmes MM, Lewith G, Newell D, Field J, Bishop FL. The impact of patient-reported outcome measures in clinical practice for pain: a systematic review. Qual Life Res. 2017;26(2):245–57.

    Article  Google Scholar 

  25. Salek S, Roberts A, Finlay AY. The practical reality of using a patient-reported outcome measure in a routine dermatology clinic. Dermatology. 2007;215(4):315–9.

    Article  Google Scholar 

  26. Young-Afat DA, Gibbons C, Klassen AF, Vickers AJ, Cano SJ, Pusic AL. Introducing BREAST-Q computerized adaptive testing: short and individualized patient-reported outcome assessment following reconstructive breast surgery. Plast Reconstr Surg. 2019;143(3):679–84.

    Article  CAS  Google Scholar 

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This research was funded in part through the NIH/NCI Cancer Center Support Grant P30CA008748. Dagmar Schnau provided editorial assistance.

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Authors and Affiliations



JAN, JJC, CMM, CSS, MGS, ALP, and BJM provided (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JAN and JJC have verified the underlying data of this study.

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Correspondence to Jonas A. Nelson MD, MPH or Jacqueline J. Chu BA.

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Andrea Pusic is a codeveloper of the BREAST-Q, which is owned by Memorial Sloan Kettering Cancer Center. She receives a portion of the licensing fees (royalty payments) when the BREAST-Q is used in industry-sponsored clinical trials. Babak Mehrara is a consultant for PureTech Corporation; received Investigator initiated grant from Regeneron. The remaining authors declare no conflicts of interest.

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Jonas A. Nelson and Jacqueline J. Chu are co-first authors.

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Nelson, J.A., Chu, J.J., McCarthy, C.M. et al. BREAST-Q REACT: Clinical Reference Values for the BREAST-Q in Post-mastectomy Breast Reconstruction Patients. Ann Surg Oncol 29, 5280–5293 (2022).

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