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Abstract

Sir:FigureWe would like to congratulate Dr. Pusic and colleagues for their significant contribution in developing the BREAST-Q. This is a valuable and welcome tool to the expanding field related to plastic surgery of the breast. The BREAST-Q has the potential to become the criterion standard in evaluating patients who have undergone plastic surgery of the breast, especially in light of the increasing demands on providing patient-centered outcomes. Each of the three modules has been developed to analyze different patient populations and include those women who have undergone breast augmentation, reduction, or reconstruction. In our recently published study, we attempted to analyze patient-centered functional outcomes and satisfaction in a cohort of patients who had undergone oncoplastic reduction mammaplasty.1 Having no prior experience using the BREAST-Q, we decided to use it for this study. Given that our patients had oncoplastic procedures, there were elements that required evaluation of the aesthetic and oncologic components that were related to the reduction and reconstruction modules. As such, certain parameters that were felt to be relevant to our cohort were included and those that were not were excluded. Dr. Pusic and colleagues have politely brought to our attention that certain errors were committed in the execution of the BREAST-Q. It is true that the term “adapted” may have been used incorrectly. Our intent was to use the reduction mammaplasty module for oncoplastic reduction outcomes because this module most closely fit the parameters that we were seeking; however, it did not completely fit. As such, some scales were included and others were excluded. All questions in our analysis are those found in the BREAST-Q. In terms of the scoring and analysis of data, there are various methods for analyzing Likert-type scales, and the choice of method depends on the distribution of the data. Our study used a method that was felt to be appropriate for the data collected. In addition, presenting the values outlined in the tables would provide readers a better understanding of the data. With all new procedures, there is a learning curve. In our attempt to provide patient-centered outcomes in this evolving field of oncoplastic surgery, the BREAST-Q has allowed us to evaluate oncoplastic reduction mammaplasty patients in a way we believed was meaningful. It was not our intention to violate the validity of the BREAST-Q but rather to find relevant aspects of it that would assist in our evaluation. We feel that our first experience with the BREAST-Q was positive, and we will continue to use it in the future; however, it will only be used as it was originally intended, to preserve the integrity and validity of the modules. Maurice Y. Nahabedian, M.D. Ketan Patel, M.D. Margaret Gatti, M.P.H. Department of Plastic Surgery, Georgetown University Hospital, and, Georgetown University School of Medicine, Washington, D.C. DISCLOSURE The authors have no financial interest in any of the products or devices mentioned in this communication.