Is Preoperative Happiness Influencing BREAST-Q Outcomes?

Background: BREAST-Q captures quality of life implications of breast reconstruction but may draw influence from the patients' psychosocial circumstances. This study aims to test: 1) positive affect is associated with higher breast satisfaction and well-being, and 2) socioeconomic status (SES) impacts this relationship.

Methods: This prospective study included breast reconstruction patients from August 2020 to October 2022. Cantril Ladder of Happiness (CLH) assessed happiness (1-5: unhappy, 6-10: happy). BREAST-Q was sent preoperatively and one, three, six, and 12 months postoperatively. Patient characteristics, oncologic treatments, perioperative details, and outcomes were collected.

Results: A total of 49 (65.3%) identified as "happy" and 26 (34.8%) identified as "unhappy". "Happy" patients were more likely to have current employment (73.5% vs. 57.7%, p=0.039) and "a lot" of social network support (53.1% vs. 50.0%, p=0.045). "Happy" patients reported higher satisfaction with their breasts at baseline (53.7±23.9 vs. 40.±40.1, p=0.029) and three months (61.1±20.1 vs. 47.8±8.5, p=0.003); higher psychosocial well-being at baseline (69.8±17.3 vs. 52.8±18.8, p<0.001) and three months (73.8±20.5 vs. 60.4±18.8, p=0.047); and higher sexual well-being at three months (57.5±28.0 vs. 33.4±17.7, p=0.007) and one year (63.1±24.0 vs. 34.6±21.8, p=0.043). Patients with higher CLH scores reported higher psychosocial (β=12.9, p<0.001) and sexual well-being (β=16.94, p<0.001).

Conclusion: "Happy" patients demonstrated higher satisfaction levels and improved psychosocial and sexual well-being compared to "unhappy" patients. SES played a role in patient satisfaction and overall well-being. Further research is warranted to identify suitable interventions, such as screening and early referral, that can help improve patient-reported outcomes for breast reconstruction patients.