Reply: Breast Cancer and Reconstruction

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We would like to thank Payne et al. for their comments on our recent articles.1–3 We agree that the normative values our studies generated for the BREAST-Q will serve as a valuable tool for ongoing and future research. We would also like to thank the authors for comparing all three recent studies, and looking for similarities and differences among the data. A notable difference that they commented on is the difference in scores for the Physical Well-being domain across the three different preoperative BREAST-Q modules.
Each BREAST-Q module, Reconstruction, Augmentation, and Reduction, is an independent patient-reported outcome instrument. As such, each was developed using qualitative interview data from separate disease-specific patient populations.4,5 Although there are similarities in structure, such as the concepts of interest (e.g., Satisfaction with Breasts, Psychosocial Well-being), the specific questions constituting each scale in the various modules are different (Table 1).6 The questions in the Physical Well-being module of the Reconstruction module are specific to physical symptoms experienced preoperatively and postoperatively by breast cancer patients undergoing reconstruction. Similarly, the questions in the Physical Well-being module of the Reduction module are specific to physical symptoms experienced preoperatively and postoperatively by patients undergoing breast reduction. Therefore, the individuals in the different studies were answering different questions to generate the respective BREAST-Q scores, limiting the ability to compare data across studies.
The exception to this is that the Mastectomy, Breast Conserving Therapy, and Reconstruction preoperative scales are identical, as preoperatively this is one patient population. These modules differ only postoperatively to reflect the different unique postoperative concepts of interest to each surgical subgroup. Therefore, the Reconstruction normative data generated with the common preoperative breast cancer scales are applicable to all of the BREAST-Q breast cancer surgical subgroups.
We would also like to thank the authors for bringing up the primary limitation of these studies: the demographics of the normative data cohorts. We agree that additional normative data generated from a more diverse population would further enrich our understanding of the BREAST-Q, and improve the use of normative data in future analyses.

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