TY - JOUR
T1 - From readability to representation
T2 - A systematic review and meta-analysis of online patient education in breast reduction and augmentation surgery
AU - Nguyen, Antoinette T.
AU - Bajaj, Kethan
AU - Li, Rena A.
AU - Adam, Tarifa H.
AU - Galiano, Robert D.
N1 - Publisher Copyright:
© 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons
PY - 2025/11
Y1 - 2025/11
N2 - Background: Online patient education materials (OPEMs) play a critical role in shaping patient decision-making for breast augmentation and reduction surgery. However, concerns persist regarding their readability, quality, and inclusivity. We present the first comprehensive systematic review and meta-analysis to evaluate OPEMs across traditional, artificial intelligence (AI)-generated, and social media platforms. Methods: We systematically reviewed 23 studies evaluating OPEMs related to breast augmentation and reduction. Outcomes included the Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) scores, DISCERN and Ensuring quality information for patients quality assessments, diversity in visual representation, and AI performance. A random-effects meta-analysis was conducted on FKGL scores and binomial test was used to assess the proportion of studies exceeding the recommended readability thresholds. Results: Meta-analysis of 3 studies revealed a pooled FKGL of 12.28 (95% CI: 11.16–13.41), with significant heterogeneity (I² = 96.4%, p < 0.0001). A binomial test confirmed that 100% of the studies evaluating readability concluded that OPEMs exceeded the sixth-grade level (p = 0.0005). Nine studies reported suboptimal content quality, with common deficiencies in risk disclosure, source attribution, and citation. Three studies found representation and linguistic disparities in educational visuals and content accessibility. AI-generated materials showed promise but often lacked surgical nuance and detail. Conclusion: Our findings suggest that OPEMs for breast surgery are consistently written above the recommended readability levels, frequently omit essential content, and exhibit inequities in representation. These findings demonstrate the need for standardizing and improving digital patient education content to meet the informational and cultural needs of all surgical candidates.
AB - Background: Online patient education materials (OPEMs) play a critical role in shaping patient decision-making for breast augmentation and reduction surgery. However, concerns persist regarding their readability, quality, and inclusivity. We present the first comprehensive systematic review and meta-analysis to evaluate OPEMs across traditional, artificial intelligence (AI)-generated, and social media platforms. Methods: We systematically reviewed 23 studies evaluating OPEMs related to breast augmentation and reduction. Outcomes included the Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) scores, DISCERN and Ensuring quality information for patients quality assessments, diversity in visual representation, and AI performance. A random-effects meta-analysis was conducted on FKGL scores and binomial test was used to assess the proportion of studies exceeding the recommended readability thresholds. Results: Meta-analysis of 3 studies revealed a pooled FKGL of 12.28 (95% CI: 11.16–13.41), with significant heterogeneity (I² = 96.4%, p < 0.0001). A binomial test confirmed that 100% of the studies evaluating readability concluded that OPEMs exceeded the sixth-grade level (p = 0.0005). Nine studies reported suboptimal content quality, with common deficiencies in risk disclosure, source attribution, and citation. Three studies found representation and linguistic disparities in educational visuals and content accessibility. AI-generated materials showed promise but often lacked surgical nuance and detail. Conclusion: Our findings suggest that OPEMs for breast surgery are consistently written above the recommended readability levels, frequently omit essential content, and exhibit inequities in representation. These findings demonstrate the need for standardizing and improving digital patient education content to meet the informational and cultural needs of all surgical candidates.
KW - Breast augmentation
KW - Breast reduction
KW - Breast surgery
KW - Digital information
KW - Health literacy
KW - Online patient education materials
UR - https://www.scopus.com/pages/publications/105017984936
UR - https://www.scopus.com/inward/citedby.url?scp=105017984936&partnerID=8YFLogxK
U2 - 10.1016/j.bjps.2025.09.013
DO - 10.1016/j.bjps.2025.09.013
M3 - Article
C2 - 41072175
AN - SCOPUS:105017984936
SN - 1748-6815
VL - 110
SP - 239
EP - 252
JO - Journal of Plastic, Reconstructive and Aesthetic Surgery
JF - Journal of Plastic, Reconstructive and Aesthetic Surgery
ER -