# BREAST-Q and the Q-portfolio: measuring what an operation left behind

Source: https://onco.cc/technologies/rejuv-measure-breast-q/  
OnCo record `rejuv-measure-breast-q` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A questionnaire built from what women actually said matters after breast surgery: satisfaction with how the breasts look and feel, and psychological, physical and sexual well-being, each scored separately. It is the reason reconstruction techniques can be compared on something other than complication rates.

## Summary

The BREAST-Q was developed from patient interviews, focus groups, expert panels and a literature review, then field tested with 1,950 women at five centres in the United States and Canada, with a 72 per cent response rate and 491 women completing a test-retest questionnaire. Its conceptual framework has six domains: "satisfaction with breasts, overall outcome, and process of care, and psychosocial, physical, and sexual well-being". It is a system rather than a single form: three modules for augmentation, reconstruction and reduction, each with a preoperative and a postoperative version.

It is built with Rasch measurement rather than classical summation, so each scale is independently scored from 0 to 100 and the scales are not added together. The published psychometrics are person separation index 0.76 to 0.95, Cronbach's alpha 0.81 to 0.96 and test-retest reproducibility 0.73 to 0.96.

Why it changed something. Before it, a reconstruction result was reported as a complication rate and a surgeon's judgement of cosmesis. The BREAST-Q made it possible to ask whether an implant-based reconstruction or an autologous flap leaves a woman more satisfied years later, and to record that a woman can be satisfied with an outcome a surgeon would score as imperfect, and dissatisfied with one a surgeon would score as excellent.

The Q-portfolio. The same method was built out into other operations and conditions: FACE-Q for facial surgery and for people living with a visible difference, BODY-Q for body contouring, CLEFT-Q, LIMB-Q. For this front the head and neck cancer work is the relevant relative, because appearance after head and neck treatment is among the hardest things the body facet of this front describes.

What it misses. It is specific by design: nothing about fatigue, nothing about lymphoedema beyond physical well-being of the chest and upper body, nothing about recurrence. Because the scales are separate there is no single number to report, which is correct measurement and inconvenient for anyone summarising a trial in one line. Licensing requires registration, as the FACIT measures do.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; measurement; instruments
- Principle: Patient interviews generate the conceptual framework, Rasch measurement constructs independently scored interval scales, and preoperative and postoperative versions of the same scales allow within-person change after an operation to be measured rather than inferred from a cross-sectional satisfaction score.
- Since: 2009
- Strengths: Built from what patients said mattered, not from what surgeons assumed; Independently scored scales, so satisfaction and well-being do not mask each other; Preoperative and postoperative versions allow genuine before-and-after comparison; A method since extended to face, body, limb and cleft surgery
- Limitations: No single summary score, which makes trial reporting awkward; Specific to the operation, so nothing on fatigue, recurrence or systemic treatment; Requires registration for use; Most validation is in North American and European samples

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Patient-reported_outcome
- Pusic et al., Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q (Plast Reconstr Surg 2009): https://doi.org/10.1097/PRS.0b013e3181aee807

## Connected records

- technologies: [A changed face and voice: body image after head and neck cancer treatment](https://onco.cc/technologies/rejuv-mind-visible-difference-head-and-neck/), [Body image after cancer treatment: how it is measured, what drives it, and what helps](https://onco.cc/technologies/rejuv-mind-body-image-after-cancer/), [FACT-G and the FACIT family: the other main questionnaire](https://onco.cc/technologies/rejuv-measure-fact-and-facit/), [How recovery is measured: the questionnaires behind the numbers](https://onco.cc/technologies/rejuv-measure-patient-reported-outcomes/), [Measuring lymphoedema: tape, bioimpedance and the quality of life scales](https://onco.cc/technologies/rejuv-measure-lymphoedema/), [What a difference has to be before a person would notice it](https://onco.cc/technologies/rejuv-measure-minimally-important-difference/)
- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- terms: [Quality of life](https://onco.cc/terms/quality-of-life/)
- bottlenecks: [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)

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