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Normative Values for the BREAST-Q
Lily R. Mundy, MD1, Anne F. Klassen, DPhil2, Andrea L. Pusic, MD3, Carolyn L. Kerrigan, MD4.
1Duke University, Durham, NC, USA, 2McMaster University, Hamilton, ON, Canada, 3Memorial Sloan Kettering Cancer Center, New York, NY, USA, 4Dartmouth University, Lebanon, NH, USA.

Purpose: The BREAST-Q measures patient satisfaction and well-being in breast surgery patients. It is a widely used, rigorously developed, patient-reported outcome questionnaire. However, there currently are no published normative values for the BREAST-Q, limiting interpretability. Our primary aim was to generate normative values for the BREAST-Q. These normative values were then used as a reference point to interpret BREAST-Q data in breast surgery patients.
Methods: Participants were recruited via the Army of Women, an online community of women with and without breast cancer that promotes breast cancer research. Participants completed one of the three unique pre-operative BREAST-Q questionnaires: Reduction, Augmentation, or Reconstruction. Inclusion criteria were female gender, age 18 years or greater, and no prior history of breast surgery or breast cancer. Analysis included descriptive statistics and a linear multivariate regression to determine variables associated with scale measures. A secondary analysis compared these normative values to a selected sample of published BREAST-Q data for reduction, augmentation and breast cancer patients. Breast cancer patients were divided into the following groups: mastectomy, lumpectomy, and reconstruction with autologous tissue or implants.
Results: A total of 3,618 women completed pre-operative BREAST-Q questionnaires: Reduction (n=1206), Augmentation (n=1211) and Reconstruction (n=1201). Mean age was 54.1 ±12.8 years, mean BMI 26.6 ±6.1, and bra-cup size ≥D was present in 39% of women (n=1403). Normative values for Satisfaction with Breasts (SwB), Psychosocial Well-being (PsWb), Sexual Well-being (SWb), Physical Well-being-Chest, and Physical Well-being-Abdomen (PhWb-C, PhWb-A) varied between modules, see Table 1. Negative predictors were BMI ≥30 and bra size ≥D. A comparison of normative scores to published breast surgery patient data for reduction, augmentation, and breast cancer are as follows. BREAST-Q scores were lower than the norm before and higher than the norm after breast reduction and augmentation, with the exception of post-operative Physical Well-being scores in augmentation patients. In patients with breast cancer, Satisfaction with Breasts scores were higher than the norm after autologous reconstruction and lower than the norm after mastectomy. Sexual Well-being scores were lower than the norm after mastectomy and lumpectomy. Physical Well-being-Chest scores were lower than the norm post-op for all breast cancer patients.
Conclusions: Normative values provide an important reference point for interpreting BREAST-Q data. Normative values will improve the quantification of the health burden of surgical breast conditions. Normative values will additionally provide clinical context for interpreting the changes in satisfaction and well-being associated with breast reduction, augmentation, and breast cancer resection and reconstruction.
Table 1. BREAST-Q Normative Values
ReductionAugmentationReconstruction
Mean±SDMean±SDMean±SD
SwB57±1654±1958±18
PsWb68±1966±2071±18
SWb55±1949±2056±18
PhWb-C76±1186±1593±11
PhWb-A78±20


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