American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Plastic Surgery

Plastic surgery deals with the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, cranio and maxillofacial structures, hand, extremities, breast and trunk, and external genitalia. It uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Special knowledge and skill in the design and surgery of grafts, flaps, free tissue transfer and replantation is necessary. Competence in the management of complex wounds, the use of implantable materials, and tumor surgery is required. Plastic surgery has been prominent in the development of innovative techniques such as microvascular and cranio-maxillofacial surgery, liposuction, and tissue transfer. The foundation of surgical anatomy, physiology, pathology, and other basic sciences is fundamental to this specialty.

Competency in plastic surgery implies a special combination of basic knowledge, surgical judgment, technical expertise, ethics, and interpersonal skills in order to achieve satisfactory patient relationships and problem resolution.

Training in the specialty of plastic surgery deals with the resection, repair, replacement, and reconstruction of defects of form and function of the integument and its underlying anatomic systems, including the craniofacial structures, the oropharynx, the trunk, the extremities, the breast, and the perineum. It includes aesthetic (cosmetic) surgery of structures with undesirable form. Special knowledge and skill in the design and transfer of flaps, in the transplantation of tissues, and in the replantation of structures are vital to these ends, as is skill in excisional surgery, in management of complex wounds, and in the use of alloplastic materials. Residency training in plastic surgery is designed to educate and train physicians broadly in the art and science of plastic and reconstructive surgery and to develop a competent and responsible plastic surgeon with high moral and ethical character capable of functioning as an independent surgeon.

A variety of educational plans will produce the desired result.

  1. All prerequisite residency training must be taken within programs accredited by the following organizations: the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada, or the American Dental Association.
  2. The curriculum for residency training in plastic surgery is two years. A program may be accredited for more than two years (such as in the integrated model or the independent model using a three-year format) when it is demonstrated that there is a clear educational rationale - consonant with the program requirements for residency education in plastic surgery as set by the Residency Review Committee for Plastic Surgery - and the objectives for residency training cannot be met in a two-year curriculum or when the program director has delineated a program with special goals that exceed those goals defined in the program requirements.

Training models: The Residency Review Committee (RRC) for Plastic Surgery recognizes two training models, independent and integrated.

A. Independent model

In the independent model of training, residents complete two or three years of concentrated plastic surgery training, with no less than 12 months of senior/chief responsibility, after successful completion of one of the following prerequisite curricula:

A minimum of three years of clinical training with progressive responsibility in the same program in general surgery. Transitional year or rotating internships may not be used to fulfill this requirement.

B. Integrated model

In the integrated model, residents complete five or six years of ACGME-accredited plastic surgery training following receipt of an MD or DO degree from an institution accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA). Graduates of schools of medicine from countries other than the United States or Canada must present evidence of final certification by the Education Commission for Foreign Medical Graduates (ECFMG).

  1. The integrated curriculum must contain no less than five or six years of surgical training under the authority and direction of the plastic surgery program director.
  2. Of these five or six years, no less than 24 months must be concentrated plastic surgery training with no less than 12 months of chief responsibility on the clinical service of plastic surgery. Residents must complete the last two years of their education in the same plastic surgery program.

For more information, visit the American Board of Plastic Surgery.

The description of this surgical specialty was adapted from a description set forth by the American Board of Medical Specialties (ABMS).

Plastic Surgery as a Career

If you are seeking a life in surgery that is exciting, interesting, fulfilling, and diverse, plastic surgery would be an excellent career choice. From the tremendous variety of conditions that fall into the plastic surgeon's area of treatment expertise, to the flexibility of professional lifestyle, plastic surgery offers practitioners lifelong satisfaction in the practice of surgery.

It is commonly perceived that plastic surgeons do nothing but cosmetic surgery. One of plastic surgery's greatest attributes, however, is the breadth of conditions that fall into the area of treatment expertise of those in the field. These include congenital, acquired, and traumatic problems. In fact, the field of plastic surgery is so broad, that subspecialties exist within the specialty of plastic surgery, including cranio-maxillofacial surgery, microvascular surgery, hand surgery, and cosmetic surgery, just to name a few. Cranio-maxillofacial surgeons treat conditions involving the bones of the face and skull, and their associated soft tissue abnormalities such as cleft lip and palate. Microvascular surgeons move tissues from one area of the body to another and reestablish blood supply and innervation to this tissue using an operating microscope and sutures that are finer than human hair. Hand surgeons treat congenital, acquired, and traumatic musculoskeletal problems of the hand and upper extremity, employing both plastic and orthopaedic surgical techniques. Burn surgeons work as part of a large team that provides intensive care for burn-injured patients and treats both acute burn wounds and chronic scars. The goal of the cosmetic surgeon is to make changes in body shape or rejuvenate areas that have been affected by aging. A plastic surgeon can choose to limit a practice to one of these areas, or practice the entire scope of plastic surgery.

Although the field of plastic surgery is broad and challenging, it offers flexibility in lifestyle not found in other surgical specialties. A plastic surgeon can enjoy a thriving practice in either an academic or private-practice setting. The focus of the practice can be toward areas such as trauma, where the work can be exciting and unpredictable. Alternatively, it can be focused on elective surgery, such as breast reconstruction or cosmetic surgery, where the lifestyle can be more controlled. One may also choose to become active in academic research in plastic surgery, which is very active in institutions across the country and around the world.

Regardless of what type of practice a plastic surgeon pursues, those who choose plastic surgery as a career can rest assured that they will continue to encounter new challenges in a field that is always changing. They will be able to design a practice that fits in with their goals in life. And most importantly, they will enjoy the satisfaction of being able to help patients in very unique and diverse ways.

Ben M. Maser, MD, Associate Fellow
Redwood City, CA