Diversity in online resources for breast reconstruction: What do patients see?

Background: Online resources are commonly used by patients to obtain informa- tion on breast reconstruction. Despite the key role of these resources in patient decisionmaking, their visual content has not yet been evaluated. This study sought to 1) characterize the presence and content of visual aids in online patient education breast reconstruction re- sources and 2) determine if the women represented in these visual aids reflect the breast reconstruction patient population in the United States. Methods: The top 10 Google websites and the first 400 Google Images containing photographs/ graphics depicting human skin for the search phrase "breast reconstruction" were analyzed. Images were categorized by content as "Before/After," "Surgical/Anatomical," "Step -byStep," or "Breast -Centric Stock Images." Image subjects were classified by skin tone into "White" or "Non -White" using the Fitzpatrick scale and by body type into "Lean" or "FullFigured." Results: In total, 471 images were analyzed. These were predominantly "Before/After" images (43.9%), followed by "Breast -Centric Stock Images" (27.4%), "Surgical/Anatomical" (24.2%), and "Step -by -Step" (4.5%). The majority of all images depicted "White" skin types (90.7%) and "Lean" body types (73.0%). "Before/After" images were more likely to show "Full -Figured" women than the other content categories (p < 0.0001) and had the highest percentage of "Non -White" skin types (35.3%). Conclusions: Our findings demonstrate that breast reconstruction online resources are not reflective of the patient population seeking reconstruction. Improving the diversity of online image resources can both better represent our diverse patient population as well as better align patient expectations with postoperative outcomes, likely improving patient satisfaction. (c) 2023 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.