Background: Breast cancer accounts for one third of new female cancer diagnoses in the U.S., with nearly 300,000 diagnoses each year. Over 100,000 patients undergo mastectomy annually, and approximately half elect for reconstruction, most commonly implant-based surgery. These procedures can improve quality of life, but benefits are not distributed equally. While disparities by race, insurance, and socioeconomic status are well documented, the role of primary language is understudied. Limited English proficiency (LEP) patients, particularly Hispanic women, face unique barriers to reconstruction. This study compared satisfaction, health literacy, and educational preferences among English-proficient (PEP) and Spanish-speaking LEP women following implant-based breast reconstruction. Methods: A cross-sectional bilingual survey was administered via REDCap to women ≥18 years who underwent implant-based reconstruction at Wake Forest Baptist Medical Center or Carolinas Medical Center. Eligible patients were identified through the i2b2 database and contacted in their preferred language. Surveys were distributed by secure Doximity text or email, with respondents selecting English or Spanish. Data were analyzed using descriptive statistics, chi-square testing, and odds ratios (OR) with 95% confidence intervals. Open-ended responses were reviewed for themes. Results: Forty women completed the survey, including 24 PEP (mean age 57 ± 8) and 16 LEP (mean age 54 ± 7). Overall satisfaction was 79.2% for PEP vs 56.3% for LEP (OR 2.96; p = 0.166). Expectations being met was reported by 66.7% of PEP vs 43.8% of LEP (OR 2.57; p = 0.199). Interpreter use was universal among LEP. Confidence with medical forms was 91.7% PEP vs 6.3% LEP (OR 165.0; p < 0.001). Cultural respect was reported by 100% of PEP vs 62.5% of LEP. PEP preferred before/after photos (50%), while LEP prioritized more time with providers (56.3%) and videos or animations (50%). One LEP respondent expressed gratitude toward providers, demonstrating how language-sensitive care can yield positive outcomes even in an English-dominant system. Conclusion: LEP women reported lower satisfaction, weaker alignment of expectations, and greater difficulty with hospital materials compared with PEP. Resource preferences also differed, with LEP patients preferring provider time and visual aids rather than written materials. Fewer LEP respondents felt their cultural background was respected, underscoring that interpretation alone does not equate to culturally competent care. These findings highlight the need for language specific educational tools and longer interpreted visits to promote equity in reconstructive care.
Waldman et al. (Mon,) studied this question.