Research
Publications involving 1000s of women from numerous countries.
Advancing Knowledge &
Improving Health Outcomes
Industry
Included in international clinical trials and post-market surveillance studies.
Benchmarking
Included in ICHOM Breast Cancer Standard Set to enable hospitals around the world to compare outcomes.
Patient Care
Built into electronic health records in multiple hospitals around the world.
Basic Scale Structure
The BREAST-Q has independent modules for breast cancer (mastectomy, breast-conserving therapy, reconstruction), augmentation and reduction/mastopexy. Each module is composed of multiple scales that can be used independently. Some scales are common to all breast cancer patients. These include (preoperatively) Satisfaction with Breasts and Psychosocial, Sexual, and Physical Well-Being Chest and (postoperatively) Satisfaction with Surgeon, Medical Team and Office Staff. We are developing new scales covering arm lymphedema, breast sensation and other important concepts.
Expectations
Given before surgery, this set of scales measures expectations of the patient in terms of the process and outcome of surgery.
Psychosocial Well-being
Measures psychosocial well-being with items that ask about body image and a woman’s confidence in social settings.
Physical Well-being
Measures pain or tightness and difficulty with mobility, such as lifting arms.
Sexual Well-being
Asks about feelings of sexual attractiveness, sexual confidence and comfort level during sex.
Satisfaction with Breasts
Items cover breast appearance, satisfaction with breasts and how bras fit and how the breasts feel to the touch.
Experience of Care
Measures satisfaction with the information provided (about complications, healing and recovery time and details of the procedure) as well as satisfaction with the surgeon, medical team and office staff.
BREAST-Q | BREAST CANCER
| MASTECTOMY | |||||||
| QUALITY OF LIFE | SATISFACTION | ||||||
| Adverse Effects Radiation | Cancer Worry | Fatigue | Physical: Chest | Breasts | Medical Team | Office Staff | Surgeon |
| Psychosocial | Sexual | Sleep | Work | ||||
| BREAST CONSERVING THERAPY | |||||||
| QUALITY OF LIFE | SATISFACTION | ||||||
| Adverse Effects Radiation | Cancer Worry | Fatigue | Physical: Chest | Breasts | Information: Radiation | Information: Surgery | Medical Team |
| Psychosocial | Sexual | Sleep | Work | Office Staff | Surgeon | ||
| RECONSTRUCTION | |||||||
| QUALITY OF LIFE | SATISFACTION | EXPECTATIONS | BREAST SENSATION | ||||
| Adverse Effects Radiation | Animation Deformity | Abdomen | Back | Abdomen | Appearance | Abnormal Sensations | Quality of Life Impact |
| Breast Pain Interference | Cancer Worry | Breasts | Impact of Drains | Coping | Implants | Return of Sensation | |
| Fatigue | Physical: Abdomen | Implants | Information: Surgery | Medical Team | Pain | ||
| Physical: Back & Shoulders | Physical: Chest | Medical Team | Nipple reconstruction | ||||
| Psychosocial | Return to Activity | Nipples | Office Staff | ||||
| Sexual | Sleep | Surgeon | |||||
| Work | |||||||
| ARM LYMPHEDEMA | |||||||
| QUALITY OF LIFE | SATISFACTION | ||||||
| Function | Psychological | Quality of Life Impact | Symptoms | Appearance | Arm Sleeve | Information | |
*Table can be scrolled to the side when on a mobile device
Publications
Select a section to see list of relevant publications
BREAST-Q DEVELOPMENT AND VALIDATION PUBLICATIONS
- Peled, A. W., Amara, D., Piper, M. L., Klassen, A. F., Tsangaris, E., Pusic, A. L. Development and Validation of a Nipple-Specific Scale for the BREAST-Q to Assess Patient-Reported Outcomes following Nipple-Sparing Mastectomy. Plast Reconstr Surg. 2019 Apr;143(4):1010-1017.
- Kaur M, Pusic A, Gibbons C, Klassen AF. Implementing electronic patient-reported outcome measures in outpatient cosmetic surgery clinics: an exploratory qualitative study. Aesthet Surg J. 2018 Oct.
- 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 Jun;33:44-49.
- Cano SJ, Klassen AF, Scott A, Alderman A, Pusic AL. Interpreting Clinical Differences in BREAST-Q Scores: Minimal Important Difference. Plast Reconstr Surg. 2014 Jul;134(1): 173e-175e.
- Cano SJ, Klassen AF, Scott AM, Pusic AL. A closer look at the BREAST-Q©. Clin Plast Surg. 2013 Apr;40(2):287-96.
- McCarthy CM, Cano SJ, Klassen AF, Scott A, Van Laeken N, Lennox PA, Cordeiro PG, Pusic AL. The magnitude of effect of cosmetic breast augmentation on patient satisfaction and health-related quality of life. Plast Reconstr Surg. 2012 Jul;130(1):218-23.
- Pusic AL, Klassen AF, Snell L, Cano SJ, McCarthy C, Scott A, Cemal Y, Rubin LR, Corderio PG. Measuring and managing patient expectations for breast reconstruction: impact on quality of life and patient satisfaction. Expert Rev Pharmacoecon Outcomes Res. 2012 Apr;12(2):149-58.
- Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL. The BREAST-Q: Further Validation in Independent Clinical Samples. Plast Reconstr Surg. 2012 Feb;129(2):293-302.
- Chen CM, Cano SJ, Klassen AF, King T, McCarthy C, Cordeiro PG, Morrow M, Pusic AL. Measuring quality of life in oncologic breast surgery: a systematic review of patient-reported outcome measures. Breast J. 2010 Nov-Dec;16(6):587-97.
- Pusic AL, Klassen A, Scott A, Klok J, Cordeiro PG, Cano SJ. Development of a New Patient Reported Outcome Measure for Breast Surgery: The BREAST-Q©. Plast Reconstr Surg. 2009 Aug;124(2):345- 53.
- Klassen A, Pusic AL, Scott A, Klok J, Cano S. Satisfaction and quality of life in women who undergo breast surgery: A qualitative study. BMC Womens Health. 2009 May 1;9:11.
- Pusic AL, Reavey PL, Klassen AF, Scott A, McCarthy C, Cano S. Measuring patient outcomes after breast augmentation: Introducing the BREAST-Q: Augmentation Module. Clin Plast Surg. 2009 Jan;36(1):23-32.
- Pusic AL, Chen CM, Cano S, Klassen A, McCarthy C, Collins ED, Cordeiro PG. Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments. Plast Reconstr Surg. 2007 Sep;120(4):823-37.
BREAST-Q NORMATIVE DATA PUBLICATIONS
- Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Recon Surg. 2017 May;139(5):1046e-1055e.
- Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Normative Data for Interpreting the BREAST-Q: Augmentation. Plast Reconstr Surg 2017 Apr;139(4):846e-853e.
- Mundy LR, Homa K Klassen AF, Pusic AL, Kerrigan CL. Understanding the health burden of macromastia: normative data for the BREAST-Q reduction module. Plast Reconstr Surg. 2017 Apr;139(4):846e-853e. Focus of video by PRS editor: http://journals.lww.com/plasreconsurg/Pages/videogallery.aspx?videoId=1085&autoPlay=true
OTHER BREAST-Q PUBLICATIONS BY MEMBERS OF OUR TEAM
- Nelson JA, Allen RJ Jr, Polanco T, Shamsunder M, Patel AR, McCarthy CM, Matros E, Dayan JH, Disa JJ, Cordeiro PG, Mehrara BJ, Pusic AL. Long-term Patient-reported Outcomes Following Postmastectomy Breast Reconstruction: An 8-year Examination of 3268 Patients. Ann Surg. 2019 Jul 26.
- Flanagan MR, Zabor EC, Romanoff A, Fuzesi S, Stempel M, Mehrara BJ, Morrow M, Pusic AL, Gemignani ML. A Comparison of Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Implant Breast Reconstruction. Ann Surg Oncol. 2019 Jul 24.
- Ng S, Pusic A, Parker E, Vishwanath S, Cooter RD, Elder E, Moore C, McNeil J, Hopper I. Patient-Reported Outcome Measures for Breast Implant Surgery: A Pilot Study. Aesthet Surg J. 2019 Jul 12;39(8):NP314-NP321.
- Taylor EM, Wilkins EG, Pusic AL, Qi J, Kim HM, Hamill JB, Guldbrandsen GE, Chun YS. Impact of Unilateral versus Bilateral Breast Reconstruction on Procedure Choices and Outcomes. Plast Reconstr Surg. 2019 Jun;143(6):1159e-1168e.
- Atisha DM, Tessiatore KM, Rushing CN, Dayicioglu D, Pusic A, Hwang S. A National Snapshot of Patient-Reported Outcomes Comparing Types of Abdominal Flaps for Breast Reconstruction. Plast Reconstr Surg. 2019 Mar;143(3):667-677.
- 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 Mar;143(3):679-684.
- Razdan SN, Panchal H, Albornoz CR, Pusic AL, McCarthy CC, Cordeiro PG, Disa JJ, Mehrara BJ, Matros E. Impact of Contralateral Symmetry Procedures on Long-Term Patient-Reported Outcomes following Unilateral Prosthetic Breast Reconstruction. J Reconstr Microsurg. 2019 Feb;35(2):124-128. Epub 2018 Aug 12.
- Coriddi M, Shenaq D, Kenworthy E, Mbabuike J, Nelson J, Pusic A, Mehrara B, Disa JJ. Autologous Breast Reconstruction after Failed Implant-Based Reconstruction: Evaluation of Surgical and Patient-Reported Outcomes and Quality of Life. Plast Reconstr Surg. 2019 Feb;143(2):373-379.
- Romanoff A, Zabor EC, Stempel M, Sacchini V, Pusic A, Morrow M. A Comparison of Patient-Reported Outcomes After Nipple-Sparing Mastectomy and Conventional Mastectomy with Reconstruction. Ann Surg Oncol. 2018 Oct;25(10):2909-2916.
- Santosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction. JAMA Surg. 2018 Oct 1;153(10):891-899.
- Klassen AF, Kaur MN, Pusic AL. Adding scales to BREAST-Q must follow the same rigor as original scales. J Plast Reconstr Aesthet Surg. 2018 Aug;71(8):1216-1230.
- Razdan SN, Panchal H, Albornoz CR, Pusic AL, McCarthy CC, Cordeiro PG, Disa JJ, Mehrara BJ, Matros E. Impact of Contralateral Symmetry Procedures on Long-Term Patient-Reported Outcomes following Unilateral Prosthetic Breast Reconstruction. J Reconstr Microsurg. 2018 Aug 12.
- Berlin NL, Hamill JB, Qi J, Kim HM, Pusic AL, Wilkins EG. Nonresponse bias in survey research: lessons from a prospective study of breast reconstruction. J Surg Res. 2018 Apr;224:112-120.
- Roth RS, Qi J, Hamill JB, Kim HM, Ballard TNS, Pusic AL, Wilkins EG. Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction. Breast. 2018 Feb;37:119-125.
- Yoon AP, Qi J, Brown DL, Kim HM, Hamill JB, Erdmann-Sager J, Pusic AL, Wilkins EG. Outcomes of immediate versus delayed breast reconstruction: Results of a multicenter prospective study. Breast. 2018 Feb;37:72-79.
- Erdmann-Sager J, Wilkins EG, Pusic AL, Qi J, Hamill JB, Kim HM, Guldbrandsen GE, Chun YS. Complications and Patient-Reported Outcomes after Abdominally Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. Plast Reconstr Surg. 2018 Feb;141(2):271-281.
- Voineskos SH, Nelson JA, Klassen AF, Pusic AL. Measuring Patient-Reported Outcomes: Key Metrics in Reconstructive Surgery. Annu Rev Med. 2018 Jan 29;69:467-479.
- Sorkin M, Qi J, Kim HM, Hamill JB, Kozlow JH, Pusic AL, Wilkins EG. Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits. Plast Reconstr Surg. 2017 Dec;140(6):1091-1100.
- Srinivasa DR, Garvey PB, Qi J, Hamill JB, Kim HM, Pusic AL, Kronowitz SJ, Wilkins EG, Butler CE, Clemens MW. Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study. Plast Reconstr Surg. 2017 Nov;140(5):869-877.
- Pusic AL, Matros E, Fine N, Buchel E, Gordillo GM, Hamill JB, Kim HM, Qi J, Albornoz C, Klassen AF, Wilkins EG. Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. J Clin Oncol. 2017 Aug 1;35(22):2499-2506.
- Billig J, Jagsi R, Qi J, Hamill JB, Kim HM, Pusic AL, Buchel E, Wilkins EG, Momoh AO. Should Immediate Autologous Breast Reconstruction be considered in Women who require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes. Plast Reconstr Surg. 2017 Feb 13.
- Kulkarni AR, Pusic AL, Hamill JB, Kim HM, Qi J, Wilkins EG, Roth RS. Factors Associated with Acute Postoperative Pain Following Breast Reconstruction. JPRAS Open. 2017 Mar;11:1-13.
- Santosa KB, Qi J, Kim HM, Hamill JB, Pusic AL, Wilkins EG. Effect of Patient Age on Outcomes in Breast Reconstruction: Results from a Multicenter Prospective Study. J Am Coll Surg. 2016 Dec;223(6):745-54.
- Howard MA, Sisco M, Yao K, Winchester DJ, Barrera E, Warner J, Jaffe J, Hulick P, Kuchta K, Pusic AL, Sener SF. Patient satisfaction with nipple-sparing mastectomy: A prospective study of patient reported outcomes using the BREAST-Q. J Surg Oncol. 2016 Sep;114(4):416-22.
- Cohen WA, Mundy L, Ballard TN, Klassen AF, Cano SJ, Browne J, Pusic AL. The BREAST-Q in surgical research: a review of the literature 2009-2015. J Plast Reconstr Aesth Surg. 2016; 69(2):149-62.
- Cohen WA, Ballard TN, Hamill JB, Kim HM, Chen X, Klassen A, Wilkins EG, Pusic AL. Understanding and Optimizing the Patient Experience in Breast Reconstruction. Ann Plast Surg. 2016 Aug;77(2):237-41.
- Alderman A, Pusic A, Murphy DK. Prospective Analysis of Primary Breast Augmentation on Body Image Using the BREAST-Q: Results from a Nationwide Study. Plast Reconstr Surg. 2016 Jun;137(6):954e-60e.
- Razdan SN, Cordeiro PG, Albornoz CR, Ro T, Cohen WA, Mehrara BJ, McCarthy CM, Disa JJ, Pusic AL, Matros E. Cost-Effectiveness Analysis of Breast Reconstruction Options in the Setting of Postmastectomy Radiotherapy Using the BREAST-Q. Plast Reconstr Surg. 2016 Mar;137(3):510e-517e.
- Macadam SA, Zhong T, Weichman K, Papsdorf M, Lennox PA, Hazen A, Matros E, Disa J, Mehrara B, Pusic AL. Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors: A Multicenter Comparison of Four Abdominally Based Autologous Reconstruction Methods. Plast Reconstr Surg. 2016 Mar;137(3):758-71.
- Macadam SA, Zhong T, Weichman K, Papsdorf M, Lennox PA, Hazen A, Matros E, Disa J, Mehrara B, Pusic AL. Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction. Breast J. 2016 Jan-Feb;22(1):10-7.
- Weichman KE, Hamill JB, Kim HM, Chen X, Wilkins EG, Pusic AL. Understanding the recovery phase of breast reconstructions: Patient-reported outcomes correlated to the type and timing of reconstruction. J Plast Reconstr Aesthet Surg. 2015 Oct;68(10):1370-8.
- Schwitzer JA, Miller HC, Pusic AL, Matros E, Mehrara BJ, McCarthy CM, Lennox PA, Van Laeken N, Disa JJ. Satisfaction following Unilateral Breast Reconstruction: A Comparison of Pedicled TRAM and Free Abdominal Flaps. Plast Reconstr Surg Glob Open. 2015 Aug 19;3(8):e482.
- Matros E, Albornoz CR, Razdan SN, Mehrara BJ, Macadam SA, Ro T, McCarthy CM, Disa JJ, Cordeiro PG, Pusic AL Cost-effectiveness analysis of implants versus autologous perforator flaps using the BREAST-Q. Plast Reconstr Surg. 2015 Apr;135(4):937-46.
- Atisha DM, Rushing CN, Samsa GP, Locklear TD, Cox CE, Shelley Hwang E, Zenn MR, Pusic AL, Abernethy AP. A national snapshot of satisfaction with breast cancer procedures. Ann Surg Oncol. 2015 Feb;22(2):361-9.
- Albornoz CR, Matros E, McCarthy CM, Klassen A, Cano SJ, Alderman AK, Vanlaeken N, Lennox P, Macadam SA, Disa JJ, Mehrara BJ, Cordeiro PG, Pusic AL. Implant Breast Reconstruction and Radiation: A Multicenter Analysis of Long-Term Health-Related Quality of Life and Satisfaction. Ann Surg Oncol. 2014; 21(7):2159-64.
- Alderman AK, Bauer J, Fardo D, Abrahamse P, Pusic A. Understanding the effect of breast augmentation on quality of life: prospective analysis using the BREAST-Q. Plast Reconstr Surg. 2014 Apr;133(4):787-95.
- McCarthy CM, Mehrara BJ, Long T, Garcia P, Kropf N, Klassen AF, Cano SJ, Li Y, Hurley K, Scott A, Disa JJ, Cordeiro PG, Pusic AL. Chest and upper body morbidity following immediate postmastectomy breast reconstruction. Ann Surg Oncol 2014; 21(1): 107-112.
- Ho AL, Klassen AF, Cano S, Scott AM, Pusic AL. Optimizing Patient Centered-Care in Breast Reconstruction: The Importance of Preoperative Information and Patient-Physician Communication. Plast Reconst Surg. 2013; 132(2):212e-20e.
- Koslow S, Pharmer LA, Scott AM, Stempel M, Morrow M, Pusic AL, King TA. Long-Term Patient-Reported Satisfaction after Contralateral Prophylactic Mastectomy and Implant Reconstruction. Ann Surg Oncol. 2013 May 30.
- Rosson GD, Shridharani SM, Magarakis M, Manahan MA, Basdag B, Gilson MM, Pusic AL. Quality of life before reconstructive breast surgery: A preoperative comparison of patients with immediate, delayed, and major revision reconstruction. Microsurgery. 2013 May;33(4):253-8.
- Macadam SA, Ho AL, Lennox PA, Pusic AL. Patient-reported satisfaction and health-related quality of life following breast reconstruction: a comparison of shaped cohesive gel and round cohesive gel implant recipients. Plast Reconstr Surg. 2013 Mar;131(3):431-41.
- Pusic AL, Klassen AF, Cano SJ. Discussion: The BREAST-Q: further validation in independent clinical trials. Plast Reconstr Surg. 2012 Sep;130(3):482e-3e; author reply 483e.
- Pusic AL, Klassen AF, Cano SJ. Use of the BREAST-Q in clinical outcomes research. Plast Reconstr Surg. 2012 Jan;129(1):166e-167e; author reply 167e.
- Zhong T, McCarthy C, Min S, Zhang J, Beber B, Pusic AL, Hofer SO. Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: a prospective analysis of early postoperative outcomes. Cancer. 2012 Mar 15;118(6):1701-9.
- McCarthy CM, Klassen AF, Cano SJ, Scott A, Vanlaeken N, Lennox PA, Alderman AK, Mehrara BJ, Disa JJ, Cordeiro PG, Pusic AL. Patient satisfaction with postmastectomy breast reconstruction: a comparison of saline and silicone implants. Cancer. 2010 Dec 15;116(24):5584-91.
- Cano S, Klassen AF, Scott A, Thoma A, Feeny D, Pusic A. Health outcome and economic measurement in breast cancer surgery: challenges and opportunities. Expert Rev Pharmacoecon Outcomes Res. 2010 Oct;10(5):583-94.
- Macadam SA, Ho AL, Cook EK Jr, Lennox PA, Pusic AL. Patient satisfaction and health-related quality of life following breast reconstruction: A comparison of patient-reported outcomes amongst saline and silicone implant recipients. Plast Reconstr Surg 2010 Mar;125(3):761-7.
Our Team
Dr Anne Klassen
McMaster University, Canada
Q-Portfolio
Dr Andrea Pusic
Brigham and Women’s Hospital, USA
Q-Portfolio
Dr Stefan Cano
Modus Outcomes, UK
Q-Portfolio
Setting the Bar in
Patient Reported
Outcome Measurement
Funding Provided By:
Giving Meaning to Differences in BREAST-Q Scores: Minimal Important Difference for Breast Reconstruction Patients. - PubMed - NCBI https://www.ncbi.nlm.nih.gov/pubmed/31577663
Deriving an overall appearance domain score by applying bifactor IRT analysis to the BODY-Q appearance scales. - PubMed - NCBI https://www.ncbi.nlm.nih.gov/pubmed/31758485
Expectations of breast-conserving therapy: a qualitative study. - PubMed - NCBI https://www.ncbi.nlm.nih.gov/pubmed/31883052
Comparison of the Moorehead-Ardelt quality of life questionnaire and the BODY-Q in Danish patients undergoing weight loss and body contouring surgery. - PubMed - NCBI https://www.ncbi.nlm.nih.gov/pubmed/31898419
Latest Q-team publication --> International phase 1 study protocol to develop a health state classification system for a preference-based measure for women with breast cancer: t... - PubMed - NCBI https://www.ncbi.nlm.nih.gov/pubmed/31915176
Development of a Patient-Reported Outcome Instrument for Patients With Severe Lower Extremity Trauma (LIMB-Q): Protocol for a Multiphase Mixed Meth... - PubMed - NCBI https://www.ncbi.nlm.nih.gov/pubmed/31625944