Is Preoperative Happiness Influencing BREAST-Q Outcomes?

The BREAST-Q captures the quality-of-life implications of breast reconstruction, but may draw influence from the patients' psychosocial circumstances. This study examined whether positive affect is associated with higher breast satisfaction and well-being, and whether socioeconomic status affects this relationship.

This prospective study included patients undergoing breast reconstruction from August of 2020 to October of 2022. The Cantril Ladder of Happiness was used to assess happiness (1 to 5, unhappy; 6 to 10, happy). The BREAST-Q was sent before surgery and 1, 3, 6, and 12 months after surgery. Patient characteristics, oncologic treatments, perioperative details, and outcomes were collected.

A total of 49 participants (65.3%) identified themselves as happy and 26 (34.8%) as unhappy. Happy patients were more likely to have current employment (73.5% versus 57.7%; P = 0.039) and "a lot" of social network support (53.1% versus 50.0%; P = 0.045). Happy patients reported higher satisfaction with their breasts at baseline (53.7 ± 23.9 versus 40.0 ± 40.1; P = 0.029) and 3 months (61.1 ± 20.1 versus 47.8 ± 8.5; P = 0.003); higher psychosocial well-being at baseline (69.8 ± 17.3 versus 52.8 ± 18.8; P < 0.001) and 3 months (73.8 ± 20.5 versus 60.4 ± 18.8; P = 0.047); and higher sexual well-being at 3 months (57.5 ± 28.0 versus 33.4 ± 17.7; P = 0.007) and 1 year (63.1 ± 24.0 versus 34.6 ± 21.8; P = 0.043). Patients with higher Cantril Ladder of Happiness scores reported higher psychosocial well-being (β = 12.9; P < 0.001) and sexual well-being (β = 16.94; P < 0.001).

Happy patients demonstrated higher satisfaction levels and improved psychosocial and sexual well-being compared with unhappy patients. SES played a role in patient satisfaction and overall well-being. Further research is warranted to identify suitable interventions, such as screening and early referral, that can help improve patient-reported outcomes for patients undergoing breast reconstruction.