December 1, 2021 – African American women are less likely to be pictured in social media posts showing the outcomes of breast reconstruction, reports a study in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Under-representation on social media might be one factor contributing to the decreasing trend in breast reconstruction after mastectomy for breast cancer in African American patients, according to the new research by ASPS Member Surgeon Robert Galiano, MD, and colleagues of Northwestern University Feinberg School of Medicine, Chicago. Dr. Galiano comments, "It behooves us as engaged advocates for our patients to utilize every tool at our disposal, including social media, to encourage patients of color to be aware of all the advances in breast cancer diagnosis, treatment, and reconstruction that are available to them."
Fewer depictions of breast reconstruction outcomes for non-white women
Social media has become an important tool for sharing information and education about plastic and reconstructive surgery, and has become "the single largest tool for patients to research a surgeon," according to the authors. Before-and-after photos of patients undergoing various types of procedures, including breast reconstruction, are an important part of these social media posts, helping to set patient expectations and giving an idea of the results achieved by individual surgeons.
Breast reconstruction has lasting benefits for women who have undergone mastectomy for breast cancer, and is required under federal law to be covered by health insurance plans. The number of women undergoing breast reconstruction appears to be increasing, according to ASPS statistics. But recent data suggest a significant 2.1 percent decrease in breast reconstruction in African American women.
Could representation on social media be a contributor to this and other racial/ethnic disparities in breast reconstruction? To find out, Dr. Galiano and colleagues analyzed images of breast reconstruction results posted by plastic surgeons on social media platforms, including Instagram, Facebooks, Real Self, and Twitter. Images were analyzed in terms of skin color. Specifically, patients with scores of 5 or 6 on the six-point Fitzpatrick scale – representing "dark brown" skin – were classified as non-white.
The analysis included a total of 2,580 before-and-after breast reconstruction photos. Only 6.7 percent of the images depicted non-white patients. In contrast, African American women accounted for about 13 percent of patients undergoing post-mastectomy breast reconstruction in 2018.
The images in the study were posted by 543 surgeons, 96 percent of whom were Board-certified plastic surgeons. Only 5 percent of the surgeons uploading images to social media were non-white. Perhaps surprisingly, non-white surgeons were less likely to post before-and-after photos of African American patients, compared to white surgeons.
Thirty percent of surgeons did not upload images of any non-white patients. Analysis of a random sample of top plastic surgery social media "influencers" found that only 5 percent of photos shared were of non-white patients.
While representation on social media may be one contributor to the decreasing rate of breast reconstruction among African American women, it is likely not the only one. Dr. Galiano and colleagues identify a number of other possible factors – including differences in scar formation in darker skin that make scars more conspicuous and noticeable in photographs.
The researchers also note that Asian and Hispanic/Latina women also have lower rates of breast reconstruction, compared to the general population. Dr. Galiano and coauthors conclude, "Future studies are needed to explore their under-representation and to investigate their presence in social media. "
About Plastic and Reconstructive Surgery
For over 75 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
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