Have you felt bombarded by terms: “cosmetic,” “aesthetic,” “plastic,” “reconstructive” when referring to the kind of surgery we specialists do? What do these terms actually mean?

Plastic surgery” refers to the entire realm of our specialty which seeks to alter. In fact the Greek word, “plastikos,” means “to mold or change.” Twenty-five years ago I became fascinated by this specialty which seeks to replace, restore, and reshape tissues unlike those surgeries which focus on removal of diseased parts. Plastic surgery spans both reconstructive and cosmetic (synonym “aesthetic”) surgery. Reconstructive surgery builds or rebuilds tissues which are abnormal, deficient, or deformed from birth, trauma, or disease, and guides them back on the path toward, but never quite completely to, normal. Cosmetic (aesthetic) surgery entails altering a variant of normal toward a different, enhanced, more visually gratifying normal. Societal “norms” may factor into the chosen normal target. So reconstructive takes abnormal toward normal, while cosmetic takes normal toward another normal. It is only a small leap from this simple code to realize that reconstructive outcomes (e.g. breast cancer reconstruction) vary widely in their appearance results, so cosmesis is also important to good reconstruction.

How about function? Is it part of plastic surgery? Yes, function often is improved as part of the outcome of plastic surgery – e.g. speech or swallowing after cleft repair, motion with scar releases, strength with hand tendon or abdominal wall repairs. Those of us who have trained and have become proficient in the entire spectrum of plastic surgery feel that there is much cross-fertilization of knowledge and technique between cosmetic and reconstructive disciplines – geometry, symmetry, subtlety, physiology, and anatomy – to take our patients from a starting point to a nicely healed final destination.

However, a disconnect seems to have been injected into the conversation, as we consider what plastic surgery falls under the coverage umbrella of health insurance companies. What are they willing to underwrite as a “covered” need? Traditionally, “reconstructive” has implied “insurable,” and “cosmetic” (“aesthetic”) as “self-pay” arenas. Twenty years ago this seemed to be the case. Today, some companies have revised coverage policies so that it may be difficult to get coverage for such operations as correcting deformities of scars from trauma or cancer therapy, or reconstruction of cleft lips or of congenitally deformed ears, or to alleviate neck and back pain of large heavy breasts. Such policy changes not only have been frustrating to patient policy-holders and physicians, but have muddied the meaning of these terms. Wish I could trade my old bowling ball for a crystal ball……