Timing Matters: A Meta-Analysis of BREAST-Q Administration in Tissue-Expander and Implant-Based Breast Reconstruction

BREAST-Q is the most widely used patient-reported outcome measure following breast reconstruction, yet no consensus exists on optimal timing or duration of administration. We analyzed BREAST-Q follow-up after implant-based reconstruction, comparing direct-to-implant (DTI) and two-stage tissue expander (TE), to determine how outcomes differ over time and when they stabilize.

Following PRISMA guidelines, PubMed, Embase, Cochrane, Ovid, and Web of Science were searched for studies administering BREAST-Q after implant-based reconstruction. Random-effects meta-analysis and meta-regression compared pooled mean scores across five domains from preoperative baseline through 2 years postoperatively.

Fourteen studies, including 3768 patients, met the inclusion criteria. Among TE patients, psychosocial well-being was higher at 12-16 months than at baseline (p = 0.022), whereas physical well-being was below baseline within the first 6 months (p = 0.028). Among DTI patients, physical well-being increased between 3 and 6 and 12-16 months (p = 0.048), then declined by 18-24 months (p = 0.031), while sexual well-being improved by 12-16 months and remained elevated through 18-24 months (p = 0.026 and p = 0.045). Pooled scores did not differ significantly between TE and DTI in any domain.

BREAST-Q outcomes remain dynamic during the first 2 postoperative years, supporting follow-up through at least 18-24 months to better capture long-term patient-reported outcomes.