Descriptive Analysis of Preoperative Breast Reconstruction Patient Expectations Using the BREAST-Q Expectations Module

Abstract

Background: Patient expectations have been shown to influence postoperative outcomes across surgical specialties. However, the impact of expectations in breast reconstruction is not well understood. The purpose of this project is to perform the first large-scale analysis and classification of BREAST-Q Expectations responses in patients undergoing implant-based reconstruction. Methods: We performed a retrospective analysis of patients who underwent postmastectomy implant-based reconstruction and completed the BREAST-Q Expectations module preoperatively between 2012 and 2021. Variables of interest included patient demographics, comorbidities, and surgical characteristics. Outcomes of interest included BREAST-Q Expectations module scores. Shapiro Wilk Normality Tests demonstrated that none of the domains had a normal distribution of scores; scores were categorized by thirds to generate thresholds for optimistic, neutral, and pessimistic scores. Results: 298 patients met criteria. The mean age of the cohort was 50.3 and the mean BMI was 25.4. Half of the patients had at least one comorbidity – most commonly obesity, followed by diabetes. About two-thirds had a psychiatric diagnosis. Scores on all domains were skewed overwhelmingly positive (expectations of Medical Team, Coping, Appearance, Self-feelings, and Sexuality) or overwhelmingly negative (expectations of Pain and Recovery), which informed score categorization and interpretation. Conclusions: Preoperative expectations in patients undergoing implant-based reconstruction skew overwhelmingly optimistic for most domains, but overwhelmingly pessimistic on expectations of Pain and Recovery. These results emphasize a need for improved preoperative patient education and counseling as well as a closer analysis of the relationship between preoperative expectations and postoperative outcomes and quality of life.