Predicting Postoperative Satisfaction with Breasts: How Important is the Preoperative BREAST-Q Score?
Minji Kim, Lillian Boe, Kathryn Haglich, Carrie Stern, Babak Mehrara, Robert Allen Jr., Evan Matros, Jonas Nelson
Memorial Sloan Kettering, USA
The ability to predict satisfaction after postmastectomy breast reconstruction (PMBR) would allow for shared decision-making and for surgeons to manage expectations. The aim of this study is to determine which factors predict patients' postoperative satisfaction and to quantify the importance of the preoperative scores on postoperative outcomes.
A retrospective analysis of patients who underwent PMBR between 2017-2021 and completed the BREAST-Q Satisfaction with Breasts at 1-year was completed. Two multiple linear regression models (Model 1 and 2), likelihood ratio tests, simple t-statistics, and sample patient dataset to predict 1-year score were performed. Preoperative Satisfaction with Breasts was included as a predictor in Model 1 and excluded in Model 2. Multiple imputation was used to account for missing preoperative scores.
2,324 patients were included. Model 1 showed that preoperative score is significantly associated with the postoperative score (β=0.09, 95% CI: 0.04,0.14, p<0.001). Both Models demonstrated that autologous reconstruction (p<0.001), psychiatric diagnoses (p<0.001), radiation p<0.001), and mastectomy weight (p<0.05) significantly affects Satisfaction with Breasts at 1-year.
Including preoperative Satisfaction with Breasts in a regression significantly improves model fit (Test Statistic=10.04, p=0.0021). The importance of the preoperative score was quantified as 3.39"” more important than race, neoadjuvant radiation, and mastectomy weight but less than adjuvant radiation, reconstruction type, and psychiatric diagnoses. Sample patients showed that preoperative score leads to a clinically meaningful difference in the postoperative score, especially if the preoperative score is either very low or very high (Table 1).
Preoperative Satisfaction with Breasts scores are critical in predicting satisfaction 1-year after PMBR. Just as preoperative vitals and work-up are carefully documented to optimize patients' outcome, providers should collect preoperative scores to preemptively predict patients' satisfaction and provide appropriate interventions.
Comparing Predicted 1 Year BREAST-Q Satisfaction with Breast Scores for Sample Data Using Model 1 and 2
| Patient 1 (preoperative score: 58) | Patient 2 (preoperative score: 30) | Patient 3 (preoperative score: 100) | ||||
| Predicted Score | 95% CI | Predicted Score | 95% CI | Predicted Score | 95% CI | |
| Model 1 (with preoperative score included) | 59.5 | (56.5, 62.5) | 57 | (53.6, 60.4) | 63.2 | (59.6, 66.8) |
| Model 2 (without preoperative score included) | 59.7 | (56.7, 62.7) | 59.7 | (56.7, 62.7) | 59.7 | (56.7, 62.7) |
We report predicted 1-year scores and 95% confidence intervals based on our estimated model coefficients and input data. Variables were held constant except for the preoperative Satisfaction with Breasts score. Without preoperative score included (Model 2), all predicted postoperative scores are 59.7. However, when including preoperative score in Model 1, the predicted postoperative scores are different, notably between patient 2 and patient 3, with a difference of 6.2. The patients' predicted scores in Model 1 are also different from their predicted scores in Model 2, especially for preoperative scores that are either very low or very high.
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