Online patient education materials for breast reconstruction show low usability and high reading levelsOnline Breast Reconstruction Resources Often Hard for Patients to Read

BACKGROUND: Online patient education materials (OPEMs) are increasingly relied upon by patients seeking information on breast reconstruction. However, the readability, quality, and cultural inclusivity of these resources remain unclear. METHODS: Following PRISMA guidelines, a systematic review and meta-analysis of OPEMs related to breast reconstruction was conducted across PubMed, Embase, and Scopus through April 2025. Eligible studies evaluated websites, videos, or AI-generated materials for readability [Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Scores (FRES), and SMOG], quality (DISCERN), or usability [Patient Education Materials Assessment Tool (PEMAT)]. Data were pooled using random-effects models. Studies lacking quantitative data were synthesized thematically. RESULTS: Twenty studies encompassing 1634 OPEMs (1038 websites and 596 videos) were included. Meta-analyses revealed that most materials required a high reading level: FKGL mean=12.68, SMOG=12.29, and FRES=42.39, all indicating difficult-to-college-level text. DISCERN quality scores averaged 2.72/5, with wide variability across sources. PEMAT scores indicated suboptimal usability: understandability=61.9% and actionability=21.9%. Thematic analysis highlighted deficiencies in risk disclosure, citation use, language accessibility, and racial/ethnic representation. Non-English materials and social media content were especially limited in cultural sensitivity and depth. CONCLUSIONS: OPEMs in breast reconstruction are often inaccessible, incomplete, and insufficiently actionable. Content from academic or institutional sources generally outperforms patient-generated and AI-based materials but still falls short of recommended standards. There is an urgent need for coordinated evidence-based guidelines to improve digital patient education in reconstructive surgery.