Patient-reported outcomes after autologous breast reconstruction: A cross-cultural analysis

Patient-reported outcomes are critical for evaluating recovery after breast reconstruction. The BREAST-Q is widely used internationally; however, it is unclear how the scores differ across countries and whether the differences reflect clinical or cultural factors. We compared BREAST-Q outcomes between patients in the United States and the Netherlands following autologous breast reconstruction.

A retrospective review was performed of patients who underwent autologous breast reconstruction at the Memorial Sloan Kettering Cancer Center (MSK; USA) and Maastricht University Medical Center (MUMC; the Netherlands) from 2016 to 2022. Patients with a preoperative and at least one postoperative BREAST-Q assessment within 2 years were included. The BREAST-Q domains including Satisfaction with Breasts, Psychosocial Well-Being, Sexual Well-Being, and Physical Well-Being (Chest and Abdomen) were analyzed. Multivariable analyses adjusted for baseline differences. Complication rates were compared.

A total of 622 patients were included; 393 were from MSK and 229 from MUMC. After adjustment, MUMC patients had significantly lower scores in Physical Well-Being of the Chest (β=-8.6, 95% CI -12 to -5.2, p<0.001) and Psychosocial Well-Being (β=-7.4, 95% CI -11 to -3.5, p<0.001). Overall complication rates were higher in the MSK cohort (43% vs. 34%, p=0.021); however, the MSK cohort had higher rates of comorbidities.

Cross-national differences exist in select BREAST-Q domains following autologous reconstruction, independent of the complication rates. These findings suggest that cultural factors may influence patient-reported outcomes. Therefore, interpretation of BREAST-Q scores should consider cultural context, and population-specific reference values may improve comparability across international cohorts.