# First Clinical Application and Validation of the Romanian BREAST-Q in Immediate and Delayed Breast Reconstruction: A Prospective Study

## TL;DR

A Romanian version of the BREAST-Q questionnaire was validated to assess quality of life after breast reconstruction, showing it improves patient well-being but radiotherapy negatively impacts satisfaction.

## Contribution

The first validated Romanian BREAST-Q instrument for evaluating quality of life after breast reconstruction is introduced and clinically validated.

## Key findings

- The Romanian BREAST-Q showed excellent reliability and sensitivity to postoperative changes in quality of life.
- Immediate and delayed breast reconstruction significantly improved psychosocial well-being and breast-related symptoms.
- Radiotherapy had a strong negative effect on postoperative breast satisfaction.

## Abstract

Breast reconstruction is an integral component of modern breast cancer surgery, aiming to restore body image and quality of life alongside oncologic treatment. Patient-reported outcome measures are essential for understanding the impact of reconstructive procedures from the patient’s perspective; however, until now, no validated Romanian instrument was available for this purpose. This study translated, culturally adapted, and clinically validated the Romanian version of the BREAST-Q Reconstruction Module. A total of 116 women completed the questionnaire before and one year after immediate or delayed implant-based or autologous breast reconstruction. The Romanian BREAST-Q demonstrated excellent reliability and sensitivity to postoperative change. Both immediate and delayed reconstruction were associated with significant improvements in psychosocial well-being and breast-related symptoms. Radiotherapy negatively affected postoperative satisfaction, while symmetrization procedures were associated with greater physical comfort. These findings support the use of the Romanian BREAST-Q for assessing patient-reported outcomes and highlight the role of breast reconstruction in improving quality of life within contemporary breast cancer care.

Objectives: Breast cancer treatment has increasingly shifted toward integrating patient-reported outcomes into surgical decision-making. However, Romania has lacked a validated instrument to evaluate quality of life (QoL) after breast reconstruction. This study aimed to translate, culturally adapt, and clinically validate the Romanian version of the BREAST-Q Reconstruction Module, and to assess postoperative changes in QoL following immediate and delayed breast reconstruction. Methods: A prospective observational study enrolled 116 patients undergoing immediate or delayed implant-based or autologous reconstruction between June 2023 and June 2024. The BREAST-Q was translated using standardized forward–backward methodology, followed by expert review, pilot testing, and psychometric validation. Patients completed preoperative and 1-year postoperative BREAST-Q questionnaires. Statistical analyses included Cronbach’s α, intraclass correlation coefficients, paired and independent t-tests, Pearson correlations, and ANCOVA to assess the impact of radiotherapy and other clinical factors on postoperative outcomes. Results: The Romanian BREAST-Q showed excellent internal consistency (α = 0.947) and strong test–retest reliability (ICC = 0.81–0.92). Both immediate and delayed reconstruction significantly improved psychosocial well-being and breast symptoms (p < 0.001). Immediate reconstruction produced modest gains in physical well-being, whereas delayed reconstruction yielded a substantial increase in breast satisfaction (effect size d = 1.33). Breast sensation significantly decreased in both cohorts. Within delayed reconstructions, deep inferior epigastric perforator (DIEP) flaps were associated with higher physical well-being, whereas latissimus dorsi (LD) flaps demonstrated slightly better sensory outcomes. Radiotherapy had a strong negative effect on postoperative breast satisfaction (p < 0.001) after adjusting for covariates. Conclusions: The Romanian BREAST-Q is a valid, reliable instrument for evaluating QoL after breast reconstruction. Reconstruction improved multiple QoL domains, although sensory decline persisted across techniques. Symmetrization and DIEP reconstruction enhanced postoperative comfort, while radiotherapy remained a major predictor of lower satisfaction. These findings support the need for integrative reconstructive strategies that address aesthetic, functional, and sensory outcomes.