ASO Author Reflections: Redefining Outcomes in Post-Mastectomy Flat Closure
Daniel Soroudi, Nisha Parmeshwar, Aileen Gozali, Merisa Piper
Abstract
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Taxonomy
TopicsBreast Implant and Reconstruction · Breast Cancer Treatment Studies · Reconstructive Surgery and Microvascular Techniques
Past
While autologous or implant-based reconstruction has long been standard following mastectomy, an increasing number of patients are opting for aesthetic flat closure.^1^ However, this population remains underrepresented in surgical outcomes research, and existing patient-reported outcome measures (PROMs), such as the BREAST-Q, were not originally designed with flat closure in mind.^2^ As a result, the quality of data available to guide shared decision-making for flat closure patients remains limited.
Present
In the source study,^3^ a mixed-methods analysis of 252 patients undergoing post-mastectomy flat closure found a 17.5% complication rate—lower than those typically reported in implant-based and autologous reconstruction cohorts.^4^ BREAST-Q survey responses indicated high satisfaction with surgeons and physical well-being, though lower satisfaction with breasts and sexual well-being. Critically, qualitative feedback from patient emails revealed that many respondents found the BREAST-Q poorly suited to their experience. Comments highlighted concerns about triggering language, noninclusive terminology, and the irrelevance of certain modules—issues that may contribute to survey nonresponse and patient disengagement.
Future
Improving patient-centered care includes expanding conversations around all surgical options, including flat closure. In parallel, existing PROMs such as the BREAST-Q may benefit from revision or expansion to better capture the goals and experiences of patients choosing flat closure. Our team is currently conducting a follow-up qualitative study using semi-structured interviews to further explore the limitations of the BREAST-Q from the patient perspective. Preliminary insights suggest opportunities to improve language, expand domain relevance, and enhance inclusivity. As the surgical field continues to embrace a broader range of patient priorities, redefining how we measure satisfaction is essential.