(Reuters Health) - Nearly 88 percent of online reviews of U.S. plastic surgeons who provide breast augmentation were found to be positive in a recent study, but that snapshot of customer satisfaction is not necessarily reliable, researchers say.

The reviews tend to be polarized at five stars or one star, and some are written by people who consulted a doctor but never had the surgery, the study authors note in the journal Plastic and Reconstructive Surgery.

“The interface between patients and physicians continues to evolve in surprising ways as the internet and social media take hold of our everyday lives,” said senior author Dr. John Kim of Northwestern University Feinberg School of Medicine in Chicago.

Recent studies have found that about 60 percent of Americans view online reviews as important when choosing a doctor, and one-third say they are affected by these reviews, Kim and his team note.

“Online reviews have become the new word-of-mouth referral for physicians,” Kim told Reuters Health by email. “But patients need to be wary of equating online reviews with actual skill and experience.”

The researchers analyzed more than 1,077 breast augmentation reviews on Google, Yelp and RealSelf for the top 10 to 20 most-reviewed plastic surgeons in six metropolitan areas: New York, Los Angeles, Chicago, Houston, Philadelphia and Miami. The first five cities represent the five most populous metro areas, and Miami has the most plastic surgeons per capita.

The study team considered a review to be positive if it had four or five stars on Google or Yelp, or a “Worth It” rating on RealSelf. One or two stars or a “Not Worth It” rating were considered negative reviews.

Positive reviews tended to cite good aesthetic outcome, good bedside manner, friendly staff and expertise as the top reasons for patient satisfaction. Only 37 reviews listed reasonable cost as a positive factor. On the other hand, the top reasons for negative reviews were poor aesthetic outcome, surgeon non-competence, the surgeon not acknowledging or taking responsibility for poor outcomes and the procedure being too expensive.

“There is a stark difference between a surgeon who has thousands of surgeries and years of experience and a limited online or social media presence and an internet-savvy surgeon with a plethora of reviews who just started a practice,” Kim said.

On average, ratings were higher on Google than on Yelp. For unknown reasons, about 37 percent of negative Yelp reviews were from people who didn’t receive surgery from the surgeon they reviewed.

Negative reviews tended to have higher word counts and were more visible, the authors note. These reviews are difficult for surgeons to contest, they write, in part because healthcare privacy rules prevent discussing details of the case.

“As reviews have become more relevant, the strategy is often to flood out negative reviews with good ones,” said Dr. Terence Myckatyn of Washington University School of Medicine in St. Louis, Missouri, who wasn’t involved in the study.

In a recent study of patient-reported outcomes for breast augmentation surgery that either did or did not use 3D computer simulation, Myckatyn and colleagues found that the majority of patients who underwent surgery were happy with their results, and the 3D simulation didn’t seem to make a difference in their patient satisfaction scores.

“Patients should interpret online reviews in a broad context and take into consideration experience, training, word-of-mouth and in-person consultations,” Myckatyn said in an email. “Make sure you’re comfortable with the interaction, surgery plan and compatibility of personalities.”

SOURCE: bit.ly/2I49uFb Plastic and Reconstructive Surgery, online May 1, 2018.