Timing Matters: A Meta-Analysis of BREAST-Q Administration in Tissue-Expander and Implant-Based Breast Reconstruction.

BACKGROUND: BREAST-Q is the most widely used patient-reported outcome measure following breast reconstruction, yet no consensus exists on optimal timing or duration of administration. We analyzed BREAST-Q follow-up after implant-based reconstruction, comparing direct-to-implant (DTI) and two-stage tissue expander (TE), to determine how outcomes differ over time and when they stabilize. METHODS: Following PRISMA guidelines, PubMed, Embase, Cochrane, Ovid, and Web of Science were searched for studies administering BREAST-Q after implant-based reconstruction. Random-effects meta-analysis and meta-regression compared pooled mean scores across five domains from preoperative baseline through 2 years postoperatively. RESULTS: Fourteen studies, including 3768 patients, met the inclusion criteria. Among TE patients, psychosocial well-being was higher at 12-16 months than at baseline (p = 0.022), whereas physical well-being was below baseline within the first 6 months (p = 0.028). Among DTI patients, physical well-being increased between 3 and 6 and 12-16 months (p = 0.048), then declined by 18-24 months (p = 0.031), while sexual well-being improved by 12-16 months and remained elevated through 18-24 months (p = 0.026 and p = 0.045). Pooled scores did not differ significantly between TE and DTI in any domain. CONCLUSION: BREAST-Q outcomes remain dynamic during the first 2 postoperative years, supporting follow-up through at least 18-24 months to better capture long-term patient-reported outcomes.