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Readability Assessment of Online Patient Resources for Breast Augmentation Surgery

Ricci, Joseph A. M.D.; Vargas, Christina R. M.D.; Chuang, Danielle J.; Lin, Samuel J. M.D.; Lee, Bernard T. M.D., M.B.A.

Plastic and Reconstructive Surgery: June 2015 - Volume 135 - Issue 6 - p 1573–1579
doi: 10.1097/PRS.0000000000001230
Cosmetic: Original Articles

Background: Patients increasingly rely on Internet resources for medical information. Well-informed patients are more likely to be active participants in their health care, contributing to higher satisfaction and better overall outcomes. Access to online patient material, however, can be limited by inadequate functional health literacy. The National Institutes of Health and the American Medical Association recommend that educational content be written at a sixth-grade reading level. This study aims to assess the readability of online patient resources for breast augmentation surgery.

Methods: A Web search for “breast implant surgery” was performed using the largest public search engine. After sponsored results were excluded, the 12 most accessed sites were identified. Patient-directed information from all relevant articles immediately linked from the main site was downloaded and formatted into plain text. The readability of 110 articles was evaluated using 10 established analyses, both overall and by Web site.

Results: The overall average readability of the 12 most popular Internet resources for breast augmentation was at a thirteenth-grade reading level (Coleman-Liau, 13.4; Flesch-Kincaid, 12.7; FORCAST, 11.3; Fry, 13; New Dale-Chall, 12.9; New Gunning Fog, 13.8; Raygor Estimate, 15; and Simple Mesaure of Gobbledygook Formula, 14.3). The Flesch Reading Ease index was 41, which falls into a “difficult” reading category. No individual article or Web site was at the recommended sixth-grade level.

Conclusions: Online resources for breast augmentation are above recommended reading levels. This may potentially serve as a barrier to patients seeking this type of surgery. Plastic surgeons should be aware of potential gaps in understanding and direct patients toward more appropriate resources.

Boston, Mass.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.

Received for publication May 4, 2014; accepted July 22, 2014.

The first authors contributed equally to this work.

Disclosure: The authors have no financial disclosures and report no conflicts of interest with any of the companies or products mentioned in this article.

Bernard T. Lee, M.D., M.B.A., Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 5A, Boston, Mass. 02215,

©2015American Society of Plastic Surgeons