Breast Reduction Pre-Op QPROM

Thank you for choosing Kinvara Private Hospital for your breast recduction 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 reduction surgery and will only take a few minutes.

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Name
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 your breasts look in clothes?
2. How your breast size matches the rest of your body?
3. The size of your breasts?
4. The shape of your breasts when you are wearing a bra?
5. How equal in size your breasts are to each other?
6. How comfortably your bras fit?
7. The shape of your breasts when you are not wearing a bra?
8. How you look in the mirror clothed?
9. How your breasts sit / hang on your chest?
10. How normal your breasts look?
11. How you look in the mirror unclothed?