Systemic Evaluation of Quality, Readability, and Integrity of Online Breast Reconstruction Resources

Patients increasingly turn to online resources for breast reconstruction information, yet the quality, readability, and inclusivity of such materials remain unclear. This study assessed top-ranking websites for content accuracy, usability, visual representation, readability, and search engine visibility.

The top 10 English-language websites were selected based on rankings from major search engines and top search engine optimization (SEO) metrics. Two independent reviewers evaluated each site using JAMA benchmarks, the DISCERN instrument, and a modified EQIP tool. Readability was assessed using Flesch-Kincaid Reading Ease, Gunning Fog, SMOG, Coleman-Liau, Automated Readability Index, and the percentage of complex words. Additional analyses examined image diversity (skin tone and body type) and content. Inter-rater reliability was confirmed using Cohen's κ and intraclass correlation coefficients.

Twelve websites were analyzed, and only 41.7% met all 4 JAMA benchmarks. DISCERN scores rated just 1 site as "excellent," with nonprofit sources performing significantly better (P = .019). EQIP findings showed only 25% were of good quality, with frequent gaps in procedural details and decision-making support. Sites covered 62.2% of essential content, with limited focus on financial aspects or patient experiences. Only 33.4% met the recommended 8th-grade reading level. Image analysis showed 76.7% of websites portrayed only light skin tones, and 71% depicted a lean body type.

Online breast reconstruction resources are often inconsistent, hard to understand, and lack diversity. More readable, inclusive, and trustworthy content is needed. Clinicians should guide patients to reliable sources and support efforts to improve online health education.