Evaluating AI's Efficacy in Enhancing Patient Education and Answering FAQs in Plastic Surgery: A Focused Case Study on Breast Reconstruction Evaluating AI's efficacy in breast surgery

Giuseppe A.G. Lombardo (1), Rosario Ranno (2), Dario Melita (3), Isidoro Musmarra (4), Paolo Marchica (5), Francesco Ciancio (6)
(1) Kore University Enna, Italy, Italy,
(2) 1. Burn & Plastic, Reconstructive and Aesthetic Surgery,,Azienda Ospedaliera Cannizzaro, Italy, Italy,
(3) Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy., Italy,
(4) Plastic, Reconstructive and Aesthetic Surgery,,Azienda Ospedaliera Cannizzaro, Italy, Italy,
(5) Department of Plastic and Reconstructive Surgery, Treviso General Hospital, Treviso, Italy. , Italy,
(6) Department of Plastic and Reconstructive Surgery, University of Bari, Italy, Italy


Background: The rapid advent of artificial intelligence (AI) and machine learning (ML) in the healthcare sector offers new horizons for patient education and has the potential to redefine patient-provider interactions. Our research aimed to gauge the efficacy of ChatGPT-4 in delivering accurate, current, and safe medical guidance on breast reconstruction, and benchmark its responses against other established patient information channels.

Methods: We presented ChatGPT-4 with six frequently posed questions about breast reconstruction. The model's replies were critically assessed by a committee of experienced plastic and reconstructive surgeons. To ensure the precision of the information, its responses were further cross-referenced against two major medical databases.

Results: The results revealed that ChatGPT-4 produced well-articulated, factually sound, and holistic answers to the presented inquiries. However, the platform showed constraints in offering tailored guidance and occasionally cited outdated or irrelevant references. Notably, the system consistently advocated for professional consultation for nuanced information.

Conclusion: ChatGPT-4 has emerged as a potential supplementary resource in patient education concerning breast reconstruction. Nevertheless, to harness its full potential and ensure its seamless integration into healthcare, further refinements and advancements in AI tools are paramount. The study underscores the importance of continuous evaluation and enhancement for AI solutions in the evolving landscape of patient education.

Full text article

Generated from XML file


Lund BD, Wang T. Chatting about ChatGPT: how may AI and GPT impact academia and libraries? Libr Hi Tech News. 2023; 40(3):26-29. doi: 10.1108/LHTN-01- 2023-0009

KingMR, chatGPT. A conversation on artificial intelligence, chatbots, and plagiarism in higher education. Cell Mol Bioeng. 2023;16(1):1-2. doi: 10.1007/s12195-022-00754-8

Sallam M. The utility of ChatGPT as an example of large language models in healthcare education, research and practice: systematic review on the future perspectives and potential limitations. medRxiv. 2023; 2023.02.19.23286155. doi: 10.1101/2023.02.19.23286155

Henn D, Momeni A. A standardized patient education class as a vehicle to improving shared decision-making and increasing access to breast reconstruction. J Plast Reconstr Aesthet Surg. 2020 Aug;73(8):1534-1539. doi: 10.1016/j.bjps.2020.02.032.

Ross RJ, Shayan R, Mutimer KL, Ashton MW. Autologous fat grafting: current state of the art and critical review. Ann Plast Surg. 2014;73(3):352-357. doi: 10.1097/SAP. 0b013e31827aeb51

Gupta R, Pande P, Herzog I, et al. Application of ChatGPT in cosmetic plastic surgery: ally or antagonist? Aesthet Surg J. 2023;43(7):NP587-NP590. doi: 10.1093/ asj/sjad042

Najafali D, Reiche E, Camacho JM, Morrison SD, Dorafshar AH. Let’s chat about chatbots: additional thoughts on ChatGPT and its role in plastic surgery along with its ability to perform systematic reviews. Aesthet Surg J. 2023;43(7): NP591-NP592. doi: 10.1093/asj/sjad056


Sigurdson L, Lalonde DH. MOC-PSSM CME article: Breast reconstruction. Plast Reconstr Surg. 2008;121(Suppl):1–12.

McCarthy CM, Mehrara BJ, Riedel E, et al. Predicting complications following expander/implant breast reconstruction: An outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg. 2008;121:1886–1892.

Cordeiro PG, Albornoz CR, McCormick B, et al. What is the optimum timing of postmastectomy radiotherapy in two-stage prosthetic reconstruction: Radiation to the tissue expander or permanent implant? Plast Reconstr Surg. 2015;135:1509–1517.

Colwell AS, Tessler O, Lin AM, et al. Breast reconstruction following nipple-sparing mastectomy: Predictors of complications, reconstruction outcomes, and 5-year trends. Plast Reconstr Surg. 2014;133:496–506.

O'Connell RL, Di Micco R, Khabra K, Kirby AM, Harris PA, James SE, Power K, Ramsey KWD, Rusby JE. Comparison of Immediate versus Delayed DIEP Flap Reconstruction in Women Who Require Postmastectomy Radiotherapy. Plast Reconstr Surg. 2018 Sep;142(3):594-605. doi: 10.1097/PRS.0000000000004676.

van der Wielen A, Negenborn V, Burchell GL, Remmelzwaal S, Lapid O, Driessen C. Less is more? One-stage versus two-stage implant-based breast reconstruction: A systematic review and meta-analysis of comparative studies. J Plast Reconstr Aesthet Surg. 2023 Aug 19;86:109-127. doi: 10.1016/j.bjps.2023.08.021.

Jeevan R, Cromwell DA, Browne JP, Caddy CM, Pereira J, Sheppard C, Greenaway K, van der Meulen JH. Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England. J Plast Reconstr Aesthet Surg. 2014 Oct;67(10):1333-44. doi: 10.1016/j.bjps.2014.04.022.

Doren EL, Miranda RN, Selber JC, Garvey PB, Liu J, Medeiros LJ, Butler CE, Clemens MW. U.S. Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Plast Reconstr Surg. 2017 May;139(5):1042-1050. doi: 10.1097/PRS.0000000000003282.

Flanagan MR, Zabor EC, Romanoff A, Fuzesi S, Stempel M, Mehrara BJ, et al. A Comparison of Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Implant Breast Reconstruction. Ann Surg Oncol. 2019 Oct;26(10):3133-3140. doi: 10.1245/s10434-019-07548-9.

Alderman AK, Hawley ST, Waljee J, Mujahid M, Morrow M, Katz SJ. Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer. Cancer. 2008 Feb 1;112(3):489-94. doi: 10.1002/cncr.23214.

Lombardo GAG, Tamburino S, Magano K, Fagone P, Mammana S, Cavalli E, Basile MS, Salvatorelli L, Catalano F, Magro G, Nicoletti F. The Effect of Omega-3 Fatty Acids on Capsular Tissue around the Breast Implants. Plast Reconstr Surg. 2020 Mar;145(3):701-710. doi: 10.1097/PRS.0000000000006553.

Persichetti P, Giovanni Lombardo GA, Marangi GF, Gherardi G, Dicuonzo G. Capsular contracture and genetic profile of ica genes among Staphylococcus epidermidis isolates from subclinical periprosthetic infections. Plast Reconstr Surg. 2011 Apr;127(4):1747-1748. doi: 10.1097/PRS.0b013e31820a6592.

Adams WP Jr. The process of breast augmentation: four sequential steps for optimizing outcomes for patients. Plast Reconstr Surg. 2008 Dec;122(6):1892-1900. doi: 10.1097/PRS.0b013e31818d20ec.

Blondeel N, Vanderstraeten GG, Monstrey SJ, Van Landuyt K, Tonnard P, Lysens R, et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg. 1997 Jul;50(5):322-30. doi: 10.1016/s0007-1226(97)90540-3.

Jabor MA, Shayani P, Collins DR Jr, Karas T, Cohen BE. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg. 2002 Aug;110(2):457-63; discussion 464-5. doi: 10.1097/00006534-200208000-00013.

O'Connell RL, Rattay T, Dave RV, Trickey A, Skillman J, Barnes NLP, Gardiner M, Harnett A, Potter S, Holcombe C; iBRA-2 Steering Group; Breast Reconstruction Research Collaborative. The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study. Br J Cancer. 2019 Apr;120(9):883-895. doi: 10.1038/s41416-019-0438-1.

Alderman AK, Wilkins EG, Kim HM, Lowery JC. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2002 Jun;109(7):2265-74. doi: 10.1097/00006534-200206000-00015.

Danino MA, Giaccone D, El Khatib A, Dimitropoulos G, Doucet O, Gagnon A, et al. Immediate breast reconstruction surgery with expander/direct implant and use of acellular dermal matrix: Does hormone therapy increases the risk of infection? Ann Chir Plast Esthet. 2020 Jul;65(4):277-283. doi: 10.1016/j.anplas.2020.03.001.

Henn D, Momeni A. A Standardized Patient Education Class as a Vehicle to Improving Shared Decision Making and Increasing Access to Breast Reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery 2020. doi: https://doi.org/10.1016/j.bjps.2020.02.032

Lund BD, Wang T. Chatting about ChatGPT: how may AI and GPT impact academia and libraries? Libr Hi Tech News. 2023; 40(3):26-29. doi: 10.1108/LHTN-01- 2023-0009

Seth I, Cox A, Xie Y, Bulloch G, Hunter-Smith DJ, Rozen WM, Ross RJ. Evaluating Chatbot Efficacy for Answering Frequently Asked Questions in Plastic Surgery: A ChatGPT Case Study Focused on Breast Augmentation. Aesthet Surg J. 2023 Sep 14;43(10):1126-1135. doi: 10.1093/asj/sjad140.

Sheets, C. S., Peat, C. M., Berg, K. C., et al. Post-operative psychosocial predictors of outcome in bariatric surgery. Obes Surg 2015; 25:330-345.

Warren, M. Defining Health in the Era of Value-Based Care: The Six Cs of Health and Healthcare. Cureus 2017;9:e1046.

Seth I, Rodwell A, Tso R, Valles J, Bulloch G, Seth N. A conversation with an open artificial intelligence platform on osteoarthritis of the hip and treatment. J Orthop Sports Med. 2023;5:112-120. doi: 10.26502/josm. 511500088

Oh N, Choi G-S, Lee WY. ChatGPT goes to the operating room: evaluating GPT-4 performance and its potential in surgical education and training in the era of large language models. Ann Surg Treat Res. 2023; 104(5): 269-273. doi: 10.4174/astr.2023.104.5.269

Clayman, M. L., Gulbrandsen, P., Morris, M. A. A patient in the clinic; a person in the world. Why shared decision making needs to center on the person rather than the medical encounter. Patient Educ Couns 2017;100:600-604

Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording E, Tomson D, Dodd C, Rollnick S, Edwards A, Barry M. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012 Oct;27(10):1361-7. doi: 10.1007/s11606-012-2077-6.

Oprea N, Ardito V, Ciani O. Implementing shared decision-making interventions in breast cancer clinical practice: a scoping review. BMC Med Inform Decis Mak. 2023 Aug 23;23(1):164. doi: 10.1186/s12911-023-02263-8.

Salwei ME, Ancker JS, Weinger MB. The Decision Aid is the Easy Part: Workflow Challenges of Shared Decision-Making in Cancer Care. J Natl Cancer Inst. 2023 Jul 8:djad133. doi: 10.1093/jnci/djad133.

Lombardo GAG, Marrella D, Stivala A, Ciancio F, Musmarra I, Catalano F, et al. Pedicle stabilization with fibrin sealant in DIEP flap breast reconstruction. Updates Surg. 2023 Dec 13. doi: 10.1007/s13304-023-01711-4.

Lombardo GAG, Stivala A, Ciancio F, Tamburino S, D'Antonio GM, Catalano F, et al. A before and after evaluation of patient reported outcomes assessed by Breast Q following LICAP turnover flap in breast conservative therapy. Updates Surg. 2023 Dec 9. doi: 10.1007/s13304-023-01714-1.


Giuseppe A.G. Lombardo
giuseppe.lombardo@unikore.it (Primary Contact)
Rosario Ranno
Dario Melita
Isidoro Musmarra
Paolo Marchica
Francesco Ciancio
Lombardo GA, Ranno R, Melita D, Musmarra I, Marchica P, Ciancio F. Evaluating AI’s Efficacy in Enhancing Patient Education and Answering FAQs in Plastic Surgery: A Focused Case Study on Breast Reconstruction: Evaluating AI’s efficacy in breast surgery. Arch Breast Cancer [Internet]. 2024 May 1 [cited 2024 May 27];11(2):147-58. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/881

Article Details