Breast Reconstruction in the Social Media Age

Machine learning analysis of online patient questions regarding breast reconstruction

BACKGROUND

Social media has become a dominant educational resource for breast reconstruction patients. Rather than passively consuming information, patients interact directly with other users and healthcare professionals. While online information for breast reconstruction has been analyzed previously, a robust analysis of patient questions on online forums has not been conducted. In this study, the authors used a machine learning approach to analyze and categorize online patient questions regarding breast reconstruction.

METHODS

Realself.com was accessed and questions pertaining to breast reconstruction were extracted. Data collected included the date of question, poster's location, question header, question text, and available tags. Questions were analyzed and categorized by two independent reviewers.

RESULTS

522 preoperative questions were analyzed. Geographic analysis is displayed in Figure 1. Questions were often asked in the pre-mastectomy period (38.3%); however, patients with tissue expanders currently in place made up 28.5%. Questions were often related to reconstructive methods (23.2%), implant selection (19.5%), and tissue expander concerns (16.7%). Questions asked in the post-lumpectomy period were significantly more likely to be related to insurance/cost and reconstructive candidacy (p < 0.01). The "Top 6″ patient questions were determined by machine learning analysis, and the most common of which was "Can I get good results going direct to implant after mastectomy?"

CONCLUSIONS

Analysis of online questions provides valuable insights and may help inform our educational approach toward our breast reconstruction patients. Our findings suggest that questions are common throughout the reconstructive process and do not end after the initial consultation. Patients most often want more information on the reconstructive options, implant selection, and the tissue expansion process.

National Trends in "Going Flat" After Mastectomy

INTRODUCTION

The "Going Flat" movement became widely publicized in 2016 and provides information and support to women who choose to forego post-mastectomy breast reconstruction (PMBR). The objectives of this study were to evaluate temporal trends in PMBR to ascertain the potential impact of this movement and assess which factors are associated with going flat.

METHODS

A retrospective cohort analysis was performed using the NCDB of women with non-metastatic breast cancer who underwent mastectomy between 2004 and 2019. Trends in going flat after mastectomy were examined and stratified by age (< 50, 50-69, ≥ 70). A multivariate logistic regression model was used to identify factors associated with going flat.

RESULTS

650,983 patients met the inclusion criteria: 244,201 (37.5%) underwent PMBR and 406,782 (62.5%) went flat. Among women < 70, rates of going flat steadily decreased from 2004 to 2015 and then stabilized after 2015, coinciding with the rise of the "Going Flat" movement. In multivariate analysis, non-White race, older age, increasing comorbidities, government provided insurance, treatment at a community program, radiotherapy, and adjuvant chemotherapy were associated with a higher likelihood of going flat (p < 0.001).

CONCLUSION

In the first 2 years after the "Going Flat" movement, the number of women going flat after mastectomy has stabilized in women < 70 for the first time in over a decade. These trends suggest that the social and cultural impact of this movement may have contributed to the stabilization of PMBR rates.

Association between the Desire for Breast Augmentation and Instagram Engagement: A Cross-Sectional Survey among Young Polish Women

The impact of social media on the eagerness to undergo aesthetic breast surgery is unknown. We aimed to evaluate the association between Instagram engagement and the willingness to undergo breast augmentation. Women aged between 19–34 years old participated in an online survey. Of the 1560 respondents, 1226 (78.59%) met the inclusion criteria. BMI, bra type, bra cup size, education, and level of activity on Instagram increased the willingness to undergo breast augmentation (OR = 1.520, p = 0.020). Moreover, concurrent Snapchat use (OR = 1.348, p = 0.024) and the number of published posts on a respondent’s Instagram accounts (reference, n > 26; 0 < n ≤ 26; OR = 0.708, p = 0.009; lack of posts (n = 0): OR = 0.702, p = 0.155) were significant drivers of the respondents’ willingness. Fashion (OR = 0.730, p = 0.021), design/architecture (OR = 0.730, p = 0.022), and models (OR = 0.623, p = 0.004) were the searched content categories that increased the desire for breast augmentation. Positive and negative feeling scores that were triggered by Instagram content were correlated with BREAST-Q scores. We concluded that Instagram is a commonly used social network service among young women, and it may drive a desire for breast augmentation. Further analyses of Instagram preferences may help assess the willingness to undergo breast surgery, and in turn assist in tailoring marketing campaigns.