Assessing Use of Gender Diverse Language in Patient Education Materials on Breast Reconstruction

Abstract

Utilizing inclusive terminology in patient education materials is an increasing area of focus in plastic surgery. Over 300,000 cases of breast cancer were diagnosed in 2020, affecting cisgender and gender diverse patients alike. Both cisgender and gender diverse patients may choose to undergo breast reconstruction. This study aims to assess the use of inclusive language in online patient education materials on reconstruction after breast cancer.

Methods: Materials were collected from all academic hospitals with a plastic surgery integrated and/or independent residency program, 97 in total. Programs were further classified by the presence of a comprehensive gender program. Materials were analyzed for gender diverse terminology outlined by the National LGBTQIA+ Health Education Center. A chi-square test evaluated for statistical significance of inclusive terminology based on the presence or absence of a comprehensive gender program.

Results: The majority (75%) of programs referenced cis women alone, with 25% referring to both men and women or using gender neutral terms such as "patients." Although most (85%) programs wrote in second person ("you"), 15% used she/her/hers pronouns alone, and no programs utilized gender diverse language outlined by the National LGBTQIA+ Health Education Center. The presence or absence of a comprehensive gender program was not predictive of the use of inclusive terminology (P = 0.32).

Conclusions: This study found that only 25% of breast reconstruction materials contained inclusive gender terminology. Plastic surgeons should provide patient education materials with language that supports members of a gender diverse population to facilitate a safe, inclusive space and conversation.

Fig. 1.

Of 97 total programs with an independent and/or integrated plastic and reconstructive surgery residency program, 72 programs referenced women alone in breast reconstruction patient education materials, and 25 programs did not specify gender within patient education materials (instead used the nonspecific “you” or the term “patient”); however, none of the programs utilized specific gender diverse terminology.

Fig. 2.

Use of gender diverse pronouns in breast reconstruction patient education materials as outlined by the National LGBTQIA+ Health Education Center. Although 15 programs used exclusively “she/her” pronouns, 83 used nonspecific pronouns (such as “you” or the term “patients”). No programs utilized “he/his,” “sie/zie,” “ze,” or “they.”