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Kim M, Matros E, Boe LA, Stern CS, Mehrara BJ, Allen RJ, Nelson JA. Predicting Postoperative Satisfaction with Breasts: How Important is the Preoperative BREAST-Q Score? Ann Surg Oncol 2024:10.1245/s10434-024-15310-z. [PMID: 39090496 DOI: 10.1245/s10434-024-15310-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/02/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The role that preoperative Satisfaction with Breast plays in a patient's postoperative course after postmastectomy breast reconstruction (PMBR) is not understood. The aim of this study is to understand the impact of the preoperative score on postoperative outcome as an independent variable. METHODS We examined patients who underwent PMBR between 2017 and 2021 and who completed the BREAST-Q Satisfaction with Breasts at 1 year postoperatively. Two multiple linear regression models (Model 1 with the preoperative Satisfaction with Breasts score and Model 2 without the preoperative score), likelihood ratio tests, simple t-statistics, and sample patient dataset to predict the 1 year score were performed. Multiple imputation was used to account for missing preoperative scores. RESULTS Overall, 2324 patients were included. Model 1 showed that the preoperative score is significantly associated with the postoperative score (β = 0.09, 95% confidence interval 0.04-0.14; p < 0.001). Comparing Model 1 and Model 2 demonstrated that including preoperative Satisfaction with Breasts in a regression significantly improves model fit (test statistic = 10.04; p = 0.0021). Using the absolute value of the t-statistics as a measure of variable importance in linear regression, the importance of the preoperative score was quantified as 3.39-more important than neoadjuvant radiation, mastectomy weight, body mass index, bilateral prophylactic mastectomy, and race, but less than adjuvant radiation, reconstruction type, and psychiatric diagnoses. CONCLUSION Preoperative Satisfaction with Breasts scores are an important independent predictor of postoperative satisfaction after PMBR. Just as vital sign and work-up are carefully documented before surgery, preoperative scores should be collected to pre-emptively gauge patients' satisfaction and optimize postoperative outcomes.
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Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lillian A Boe
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Beaulieu-Jones BR, Fefferman A, Woods AP, Shewmaker G, Zhang T, Roh DS, Sachs TE, Merrill A, Ko NY, Cassidy MR. Impact of Race, Ethnicity, Primary Language, and Insurance on Reconstruction after Mastectomy for Patients with Breast Cancer at an Urban, Academic Safety-Net Hospital. J Am Coll Surg 2023; 236:1071-1082. [PMID: 36524735 DOI: 10.1097/xcs.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Disparities in breast reconstruction have been observed in national cohorts and single-institution studies based on race, ethnicity, insurance, and language. However, little is known regarding whether safety-net hospitals deliver more or less equitable breast reconstruction care in comparison with national cohorts. STUDY DESIGN We performed a retrospective study of patients with either invasive breast cancer or ductal carcinoma in situ diagnosed and treated at our institution (January 1, 2009, to December 31, 2014). The rate of, timing of, and approach to breast reconstruction were assessed by race, ethnicity, insurance status, and primary language among women who underwent mastectomy. Reasons for not performing reconstruction were also analyzed. RESULTS A total of 756 women with ductal carcinoma in situ or nonmetastatic invasive cancer were identified. The median age was 58.5 years, 56.2% were non-White, 33.1% were non-English-speaking, and 48.9% were Medicaid/uninsured patients. A total of 142 (18.8%) underwent mastectomy during their index operation. A total of 47.9% (n = 68) did not complete reconstruction. Reasons for not performing reconstruction included patient preference (n = 22), contraindication to immediate reconstruction (ie, locoregionally advanced disease prohibiting immediate reconstruction) without follow-up for consideration of delayed reconstruction (n = 12), prohibitive medical risk or contraindication (ie, morbid obesity; n = 8), and progression of disease, prohibiting reconstruction (n = 7). Immediate and delayed reconstruction were completed in 43.7% and 8.5% of patients. The rate of reconstruction was inversely associated with tumor stage (odds ratio 0.52, 95% CI 0.31 to 0.88), but not race, ethnicity, insurance, or language, on multivariate regression. CONCLUSIONS At a safety-net hospital, we observed rates of reconstruction at or greater than national estimates. After adjustment for clinical attributes, rates did not vary by race, ethnicity, insurance or language. Future research is needed to understand the role of reconstruction in breast cancer care and how to advance shared decision-making among diverse patients.
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Affiliation(s)
- Brendin R Beaulieu-Jones
- Department of Surgery (Beaulieu-Jones), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Ann Fefferman
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Alison P Woods
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Woods)
| | - Grant Shewmaker
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Tina Zhang
- Department of Medicine (Zhang), Boston University, Boston, MA
| | - Daniel S Roh
- Section of Plastic and Reconstructive Surgery (Roh), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Teviah E Sachs
- Section of Surgical Oncology (Sachs, Merrill, Cassidy), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Andrea Merrill
- Section of Surgical Oncology (Sachs, Merrill, Cassidy), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Naomi Y Ko
- Section of Hematology and Oncology (Ko), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Michael R Cassidy
- Section of Surgical Oncology (Sachs, Merrill, Cassidy), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
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