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

<b>Objectives:</b> 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. <b>Methods:</b> 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 <i>t</i>-tests, Pearson correlations, and ANCOVA to assess the impact of radiotherapy and other clinical factors on postoperative outcomes. <b>Results:</b> 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. <b>Conclusions:</b> 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.