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Updated: Aug 13, 2026
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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Timing Matters: A Meta-Analysis of BREAST-Q Administration in Tissue-Expander and Implant-Based Breast Reconstruction
Emanuella M Brito1,2, Isabel Bernal3, Sean K Park4
1Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Journal of Surgical Oncology
|August 10, 2026
Summary
Patient-reported outcomes after breast reconstruction using BREAST-Q are dynamic for up to two years. Follow-up should extend to 18-24 months to capture long-term results for direct-to-implant (DTI) and tissue expander (TE) methods.
Area of Science:
- Plastic Surgery
- Patient-Reported Outcomes
- Health Outcomes Research
Background:
- BREAST-Q is a key patient-reported outcome measure for breast reconstruction.
- Optimal timing and duration for BREAST-Q administration remain undefined.
- This study analyzes BREAST-Q follow-up to clarify outcome trajectories.
Purpose of the Study:
- To compare BREAST-Q outcomes over time for direct-to-implant (DTI) versus two-stage tissue expander (TE) breast reconstruction.
- To determine when patient-reported outcomes stabilize after implant-based breast reconstruction.
Main Methods:
- Systematic literature search following PRISMA guidelines across major databases (PubMed, Embase, Cochrane, Ovid, Web of Science).
- Random-effects meta-analysis and meta-regression of pooled mean BREAST-Q scores.
- Analysis covered five domains from baseline through 2 years postoperatively.
Main Results:
- Fourteen studies with 3768 patients were included.
- Tissue expander (TE) patients showed improved psychosocial well-being at 12-16 months but reduced physical well-being early post-op.
- Direct-to-implant (DTI) patients experienced initial physical well-being gains, followed by a decline, while sexual well-being improved and sustained.
- No significant differences in pooled scores were observed between TE and DTI reconstruction methods.
Conclusions:
- BREAST-Q outcomes demonstrate significant changes within the first two years after implant-based breast reconstruction.
- Extended follow-up, up to 18-24 months, is recommended to fully assess long-term patient-reported outcomes.
- Understanding these temporal changes is crucial for managing patient expectations and optimizing care pathways.
