OBJECTIVE EVALUATION OF COSMETIC OUTCOME – QUALITY CONTROL ON BREAST RECONSTRUCTIVE SURGERY

MAURÍCIO MAGALHÃES COSTA, MD, PHD

Abstract: Quality assurance is the process by which quality care can be assessed. The general principles include setting a standard with the aim of achieving particular outcomes, followed by the evaluation of parameters that allow for quality assessment. Locoregional and survival outcomes are the major parameters but require years to evaluate and have other limitations. Other parameters therefore may assist in evaluation, such as the availability of the structures and processes required to achieve desired outcomes. The surgery should be performed by someone with the required training, whether plastic or oncoplastic and this is an important quality assurance issue for the patient. Immediate breast reconstruction is widely gaining acceptance, however, there continues to be a place for delayed reconstruction. This presents a new challenge to breast surgeons and allows for better planning of
the primary operation when reconstruction is undertaken by the same individual. Quality control in breast reconstruction is difficult to quantify, its availability to patients requiring breast cancer surgery by surgeons properly trained in the speciality is fast becoming a quality issue for breast units.

There is increasing demand for patient-reported outcome instruments in cosmetic and reconstructive breast surgery research and clinical practice. The BREAST-Q consists of procedure-specific modules (ie, Augmentation, Reduction/Mastopexy, Mastectomy, Reconstruction) with independent scales that examine the issues that are most important to women who have undergone each procedure.

The use of Rasch measurement methods to develop and test the scales of the BREAST-Q means that there is a good understanding of the empirical item order across each scale, improving the ability to interpret the clinical meaning of scores as well as changes in scores.The BREAST-Q can be used to study the impact and effectiveness of breast surgery from the patient’s perspective. By quantifying satisfaction and important aspects of health-related quality of life, the BREAST-Q has the potential to support advocacy, quality metrics, and an evidence-based approach to surgical practice.

Keywords: Quality assurance, breast reconstructive surgery, Quality control