Comparing BREAST-Q Scores by Race Among Patients Who Underwent Breast Reconstruction: A Global Systematic Review and Meta-Analysis

Background Breast reconstruction (BR) is an important component of comprehensive breast cancer care. Racial minorities often face barriers to BR access and worse clinical outcomes versus White counterparts. We sought to (1) compare BREAST-Q scores by race among BR patients at least one year post-reconstruction; (2) synthesize mean BREAST-Q scores by race; and (3) summarize reconstruction characteristics. Methods In this systematic review and meta-analysis, MEDLINE, Embase, Web of Science, and CENTRAL were searched from inception to August 13, 2025 for studies comparing postoperative BREAST-Q outcomes by race globally. Risk of bias was assessed using ROBINS-E. Primary outcomes were the literature-pooled mean differences (MD) in satisfaction with breasts, and psychosocial, sexual, and physical (chest) well-being domains among White versus non-White patients, evaluated with a random-effects meta-analysis. We secondarily pooled mean BREAST-Q outcomes by race and described reconstruction characteristics. Results Eleven studies were included, encompassing 8108 White, 702 Black, 1037 Asian, 0 American Indian or Alaska Native, and 0 Native Hawaiian/Pacific Islander BR patients. White patients reported significantly higher satisfaction with breast scores compared to Black patients (MD = 5.25; 95% CI [2.90, 7.59]; I 2 = 0%; p < .0001), exceeding the minimal important difference. No significant difference was found in BREAST-Q scores of White and Black patients for psychosocial, sexual, and physical (chest) well-being. Conclusion White patients reported higher postoperative breast satisfaction than Black patients. Future research should use standardized, race-specific BREAST-Q reporting, while validating the measure across diverse populations to clarify and address structural causes of satisfaction disparities.