Timing Matters: A Meta-Analysis of BREAST-Q Administration in Tissue-Expander and Implant-Based Breast Reconstruction
In brief
BREAST-Q scores keep changing for up to two years after reconstruction
A meta-analysis of 3,768 implant-based reconstructions found that patient-reported psychosocial, physical and sexual well-being scores fluctuate throughout the first 18-24 months, with no steady plateau. Scores between tissue-expander and direct-to-implant groups were similar, indicating that clinicians should schedule BREAST-Q assessments through at least two years to capture true outcomes.
- Journal
- Journal of surgical oncology (Q1)
- Published
- 10 August 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Emanuella M Brito, Isabel Bernal, Sean K Park, Julia L Armstrong, Natalia Correa, Anthony Pasarin, et al.
- PMID
- 42574595
- DOI
- 10.1002/jso.70374
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 13 August 2026): BREAST‑Q timing meta‑analysis
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.