Reconstructive Surgery and Cosmetic Surgery Are Not the Same


Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.

June 27 2008

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If you think the most common type of surgery done by plastic surgeons is breast augmentation, think again. If your second guess is liposuction, you are still wrong. Don't guess face lifts, either.

The most common type of surgery done by plastic surgeons is tumor removal. It is one of the many forms of reconstructive surgery that plastic surgeons and other surgeons perform every year. And the numbers are not even close when compared to the top-ranking cosmetic surgical procedures. In 2007, there were 11 tumor removal surgeries for every breast augmentation surgery, the leading cosmetic surgery procedure.

In 2007, about three in every four plastic surgeries were reconstructive in nature, according to statistics from the American Society for Plastic Surgery (ASPS). There were 1,837,118 cosmetic surgical procedures and 5,159,669 reconstructive procedures last year.

What Is Cosmetic Surgery?

Cosmetic surgery is performed on a normal body to enhance appearance. Reconstructive surgery returns the body to normal form, function, or appearance. It sometimes seems that all the attention goes to cosmetic plastic surgery, and that the only patients a plastic surgeon sees are just trying to look a bit younger or a bit better. But most plastic surgery patients are trying to get back function or normality. You can put it this way: cosmetic surgery is the surgery you want and reconstructive surgery is the surgery you need.

The ASPS collects statistics on all types of plastic surgery performed by its members, other surgeons certified by the American Board of Plastic Surgery, and surgeons certified by other medical boards that are recognized by the American Board of Medical Specialties. This would include cosmetic or reconstructive surgery procedures performed by dermatologists, ophthalmologists, otolaryngologists (ear, nose, and throat doctors), and general surgeons.

What Is Reconstructive Surgery?

Reconstructive surgery is most often done to repair damage done by disease (such as tumors), birth defects, or accident. Plastic surgeons are often called in to repair ripped flesh and broken bones to ensure that scarring is kept to a minimum. They fix the broken nose that impedes breathing and the cleft lip that prevents a baby from feeding properly.  A poorly healed laceration that scars badly will not only be unsightly, it also can impair function. Bad scars can pull skin out of shape and limit motion, not just provoke stares and rude questions, as if that wasn't bad enough.

The top four reconstructive surgery procedures after tumor removal in 2007 were laceration repair, scar revision, hand surgery, and breast reduction, according to the ASPS. Other categories of reconstructive surgery include breast reconstruction, burn care, maxillofacial surgery, dog bite repair, birth defect reconstruction, and microsurgery. The ASPS also included a category for "other reconstructive procedures" in their statistics.

Curiously, most types of reconstructive surgery have dropped in numbers since 2000. There were 16% fewer tumor removal procedures in 2007 then there were in 2000 and 32% fewer hand surgeries.
"We wish the number of reconstructive plastic surgery procedures was waning because fewer people are getting sick or injured," said Richard A. D'Amico, MD, president of the ASPS. "Rather, we think it has to do with extenuating circumstances like insurers denying claims and stating medically necessary procedures are cosmetic."

However, the number of breast reduction surgeries has increased. There was an increase of 25% for breast reduction from 2000 to 2007 and 2% from 2006 to 2007, according to the ASPS.
Although reconstructive work is the leading type of plastic surgery, according to the ASPS statistics, there are actually more cosmetic procedures done if minimally invasive procedures—ones that are nonsurgical in nature—are considered. Minimally invasive procedures include Botox® Cosmetic injections (the leading one), chemical peels, filler injections, and microdermabrasion.