| BREAST-Q |
| With your breasts in mind, in the past week, how often have you felt: |
| 1 - None of the time |
| 2 - A little of the time |
| 3 - Some of the time |
| 4 - Most of the time |
| 5 - All of the time |
| a) Confident in a social setting? |
| b) Emotionally capable of doing the things you want to do? |
| c) Emotionally healthy? |
| d) Of equal worth to other women? |
| e) Self-assured? |
| f) Feminine in your clothes? |
| g) Accepting your body? |
| h) Normal? |
| i) Like other women? |
| j) Attractive? |
| Thinking of your sexuality, since your breast reduction, how often do you generally feel: |
| a) Sexually attractive in your clothes? |
| b) Comfortable/at ease during sexual activity? |
| c) Confident sexually? |
| d) Satisfied with your sex life? |
| e) Confident sexually about your breast area appearance when undressed? |
| f) Sexy when undressed? |
| With your breasts in mind, in the past week, how satisfied or dissatisfied have you been with: |
| 1 - Very dissatisfied |
| 2 - Somewhat dissatisfied |
| 3 - Somewhat satisfied |
| 4 - Very satisfied |
| a) How you look in the mirror? |
| b) How comfortably does your bras fit? |
| c) Being able to use more fitted clothes? |
| d) How do you look in the mirror undressed? |
| During the past week, how satisfied or dissatisfied have you been with: |
| a) Your appearance in the mirror while dressed? |
| b) The shape of your reconstructed breast when wearing a bra? |
| c) How normal you feel in your clothes? |
| d) The size of your reconstructed breasts? |
| e) Your ability to wear more fitted clothing? |
| f) How well your breasts are aligned with each other? |
| g) How comfortably your bra fits? |
| h) The softness of your reconstructed breast? |
| i) How similar in size your breasts are to each other? |
| j) How natural your reconstructed breast looks? |
| k) How naturally your reconstructed breasts sit/position themselves? |
| l) How your reconstructed breasts feel when touched? |
| m) How much your reconstructed breast feels like a natural part of your body? |
| n) How similar your breasts are to each other? |
| o) Your appearance in the mirror while undressed? |
| If you have implants in both breasts, answer thinking about the breast you are least satisfied with. During the past week, how satisfied or dissatisfied have you been with: |
| a) The amount of rippling or wrinkling in your implant that you can see? |
| b) The amount of rippling or wrinkling in your implant that you can feel? |
| During the past week, how often have you experienced: |
| 1 - None of the time |
| 2- Some of the time |
| 3 - All of the time |
| a) Chest muscle pain? |
| b) Difficulty lifting or moving your arms? |
| c) Difficulty sleeping because of discomfort in the breast area? |
| d) Regions of hardness in the breast area? |
| e) Tightness in the breast area? |
| f) Dscomfort in the breast area? |
| g) Tenderness in the breast area? |
| h) Sharp pain in the breast area? |
| i) Aching pain in the breast area? |
| j) Tingling in the breast area? |
| k) Swelling in the arm (lymphedema) on the side where you had your mastectomy? |
| During the past week, thinking about your abdomen, how often have you experienced: |
| 1 - None of the time |
| 2 - A little of the time |
| 3 - Some of the time |
| 4 - Most of the time |
| 5 - All of the time |
| a) Difficulty sitting up because of abdominal muscle weakness (e.g., getting out of bed)? |
| b) Difficulty performing daily activities because of abdominal weakness (e.g., making the bed)? |
| c) Abdominal discomfort? |
| d) Abdominal swelling? |
| Nipple reconstruction: How satisfied or dissatisfied are you with: |
| a) How natural your reconstructed nipples and areolae look? |
| Latissimus dorsi: During the past week, thinking about your back, how often have you been bothered by: |
| 1 - None of the time |
| 2 - A little of the time |
| 3 - Some of the time |
| 4 - Most of the time |
| 5 - All of the time |
| a) The location of the scar on your back? |
| b) The length of the scar on your back? |
| c) How visible the scar on your back is to others? |
| d) Your back not looking symmetrical? |
| e) The appearance of your back? |
| f) The shape of your back? |
| g) The appearance of the scar on your back? |
| h) Having to wear certain clothes to hide your back scars? |
| Latissimus dorsi: During the past week, thinking about your shoulder and back, how often have you experienced: |
| a) Shoulder stiffness? |
| b) Shoulder pain? |
| c) Back pain? |
| d) Difficulty performing activities with your arms above your head? |
| e) Difficulty performing activities with your arms extended? |
| f) Arm weakness? |
| g) Difficulty performing activities that repeatedly use your shoulder and back muscles? |
| h) Stiffness when extending your arm? |
| i) A pulling or twinging sensation in your back? |
| j) Difficulty reaching for objects? |
| k) Difficulty carrying heavy objects? |
| If you have received radiation in both breasts, answer thinking about the breast you are least satisfied with. During the past week, how concerned have you been about: |
| 1 - Not at all |
| 2 - A little |
| 3 - Very much |
| a) The skin of your breast looking different (e.g., much lighter or darker)? |
| b) Marks on the skin of your breast caused by radiation therapy (e.g., small blood vessels)? |
| c) The skin of your breast feeling dry due to radiation therapy? |
| d) The skin of your breast being sore or sensitive to touch due to radiation (e.g., with temperature changes or bathing)? |
| e) The skin of your breast feeling thick, rough, or dry when touched? |
| f) Skin irritation from clothing due to radiation therapy? |
| How satisfied or dissatisfied were you with the information you have received from your plastic surgeon about: |
| 1 - Very dissatisfied |
| 2 - Somewhat dissatisfied |
| 3 - Somewhat satisfied |
| 4 - Very satisfied |
| a) How reconstructive surgery was to be done? |
| b) Healing and recovery time? |
| c) Possible complications? |
| d) The options you were given regarding the timing of your breast reconstruction (i.e., at the same time as the mastectomy or later)? |
| e) The options were given regarding the type of surgery? |
| f) The pros and cons of the timing of your breast reconstruction? |
| g) How long would the breast reconstruction process take from start to finish? |
| h) What size you could expect your breasts to have after surgery? |
| i) How much pain could you expect during recovery? |
| j) What could you expect your breasts to look like after surgery? |
| k) How long after reconstructive surgery would it take for you to feel normal again? |
| l) How the surgery could affect future breast cancer screening (e.g., ultrasound, mammogram, self-examinations)? |
| m) The lack of sensitivity in your reconstructed breasts and nipples? |
| n) The experience of other women with their breast reconstruction surgeries? |
| o) What the scars would look like? |
| These questions are about your plastic surgeon. Did you feel that he/she: |
| 1 - Definitely disagree |
| 2 - Somewhat disagree |
| 3 - Somewhat agree |
| 4 - Definitely agree |
| a) Was competent? |
| b) Gave you confidence? |
| c) Involved you in the decision-making process? |
| d) Was reassuring? |
| e) Answered all your questions? |
| f) Made you feel comfortable? |
| g) Was thorough? |
| h) Was easy to talk to? |
| i) Understood what you wanted? |
| j) Was sensitive? |
| k) Listened to your concerns? |
| l) Was available when you had concerns? |
| These questions are about members of the medical team other than the surgeon (e.g. nurses and other doctors who looked after you on the day you had your surgery). Did you feel that they: |
| a) Were professional? |
| b) Treated you with respect? |
| c) Were knowledgeable? |
| d) Were friendly and kind? |
| e) Made you feel comfortable? |
| f) Were thorough? |
| g) Listened to your concerns? |
| These questions are about members of the office staff (e.g. secretaries, office or clinic nurses). Did you feel that they: |
| a) Were professional? |
| b) Treated you with respect? |
| c) Were knowledgeable? |
| d) Were friendly and kind? |
| e) Made you feel comfortable? |
| f) Were thorough? |
| g) Listened to your concerns? |
Oncoplastic Reconstruction of the Contralateral Breast Using the Liacyr Pedicle without Prosthetic Implants
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