COSMIN database

Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments

Pusic, A. L., Chen, C. M., Cano, S., Klassen, A., McCarthy, C., Collins, E. D., and Cordeiro, P. G.
BACKGROUND: Patient-reported outcomes in cosmetic and reconstructive breast surgery are increasingly important for clinical research endeavors. Traditional surgical outcomes, centered on morbidity and mortality, remain important but are no longer sufficient on their own. Quality of life has become a crucial research topic augmenting traditional concerns focused on complications and survival. Given this, reliable and valid patient questionnaires are essential for aesthetic and reconstructive breast surgeons.

METHODS: The authors performed a systematic literature review to identify patient-reported outcome measures developed and validated for use in cosmetic and reconstructive breast surgery patients. Qualifying instruments were assessed for adherence to international guidelines for health outcomes instrument development and validation.

RESULTS: The authors identified 227 health outcomes questionnaires used in breast surgery studies. After 135 generic instruments, 65 ad hoc instruments, seven oncologic instruments, 11 education questionnaires, and two non-English-language questionnaires were excluded, seven measures remained. Detailed analysis revealed that six of the seven measures had undergone limited development and validation. Only one measure, the Breast-Related Symptoms Questionnaire, demonstrated adequate development and validation in its target population. It had, nevertheless, significant content limitations.

CONCLUSIONS: Valid, reliable, and responsive instruments to measure patient-reported outcomes in cosmetic and reconstructive breast surgery are lacking. To demonstrate the benefits of aesthetic and reconstructive breast surgery, future research to rigorously develop and validate new cosmetic and reconstructive breast surgery-specific instruments is needed.
Plast Reconstr Surg
1529-4242 (Electronic)
Publication year:
823-37; discussion 838-9
Symptom status:
Physical state
General health perceptions / HRQoL:
Health-related quality of life
Overall quality of life:
Overall quality of life
Adults (18-65)
Seniors (65+)
Codes for special purposes
Diseases of and symptoms related to the skin and subcutaneous tissue
Mental and behavioural disorders and related symptoms
Neoplasms and related symptoms
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
6 - Clinical rating scales
BEQ - Breast Evaluation Questionnaire
BIRS - Breast Implant Replacement Study
BRSQ - Breast-Related Symptoms Questionnaire
Dow Corning questionnaire
MBROS-BI - Michigan Breast Reconstruction Outcomes Study-Body Image questionnaire
MBROS-S - Michigan Breast Reconstruction Outcomes Study-Satisfaction questionnaire
McGhan Instrument