Breast Augmentation Pre-Op QPROM

Thank you for choosing Kinvara Private Hospital for your breast enlargement surgery. Please complete this short questionnaire (known as a Quality Patient-Reported Outcome Measure – QPROM).

The questionnaire should only be completed by patients who are due to have breast enlargement surgery and will only take a few minutes.

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Date of birth
Which breasts are you having surgery on?

With your Breasts in mind, in the past week, how dissatisfied or satisfied have you been with:

1. How you look in the mirror clothed?
2. How your breasts match the rest of your body?
3. How your bra fits?
4. How much cleavage you have when you wear a bra?
5. The size of your breasts?
6. How you look in the mirror unclothed?