Do we practice what we teach: assessing trauma-informed breast exams in breast surgery literature

Glove use is a potentially critical yet often overlooked aspect of conducting trauma-informed breast examinations for breast surgery. This practice may greatly improve patient care and prevent retraumatization of vulnerable patients, such as survivors of sexual assault, transgender and gender-diverse individuals, and adolescents. In this study, glove-use practices during breast exams depicted in breast surgery literature were investigated to understand their alignment with principles of trauma-informed care. We conducted a cross-sectional analysis of published figures spanning 75 years (1948–2023) to assess glove use practices in four surgical journals, with a focus on breast surgery. The data were analyzed using descriptive statistics and univariate logistic regression models. Fischer’s exact tests were used for temporal analysis with the data grouped into decades. 7,759 papers were assessed, and 266 figures met the inclusion criteria. In total, 18 figures (6.8%) depicted an examiner using gloves during a breast examination, and glove use over time has remained consistently low since 1957 (p-value = 0.368). Presumed male and female practitioners used gloves in 5/70 (7.1%) and 0/15 (0%) of the figures analyzed. There is minimal glove use depicted in breast-related surgery literature, and limited progress has been made in improving glove use practices over time. Our findings provide valuable information about how practitioners can provide trauma-informed care for breast surgery patients.

Level of evidence: Not ratable.