RECONSTRUCTIVE AND RESTORATIVE CUES IMPROVE PUBLIC PERCEPTION ON THE VALUE OF PLASTIC AND RECONSTRUCTIVE SURGERIES
Helen Xun, BS1, Erica Lee, BS, MS1, Pooja Yesantharao, BS, MS1, Leen el Eter, BS1, Jonlin Chen, BS1, Franca Kraezlin, MD1, Sarah Persing, MD1, Justin Sacks, MD, MBA, FACS2.
1Johns Hopkins School of Medicine, Baltimore, MD, USA, 2Washington University in St. Louis, St. Louis, MO, USA.
BACKGROUND: Persistent public misconceptions of plastic and reconstructive surgery (PRS) result in undervaluing of the critical role PRS plays in patient care: in a 2015 study, the public ranked plastic surgery lowest of 30 specialties in terms of importance in providing care for patients within the hospital (de Blacam C et al, 2015). This may be in part due to the ambiguity between cosmetic versus reconstructive surgical procedures. Our study analyzes how cosmetic or reconstructive/restorative cues affect public perception of aesthetic outcomes, and value of surgery.
METHODS: We distributed QualtricsTM surveys to laypersons in an IRB exempt study. Demographics were self-reported. The survey presented a series of pre- and post-operative photographs of PRS surgeries alongside either a cosmetic cue (patient seeking procedure for cosmetic reasons) or reconstructive/restorative cue (patient seeking procedure to restore form and function following medical or traumatic events), and asked about their perceptions of the procedure. Survey responses were analyzed using two-tailed Student’s t tests and chi square analyses, univariate and multivariate analysis, and linear regression.
RESULTS: The survey generated 459 complete responses. The mean age of the sample size was 38.5 +/- 12.1 years, of which 50.5% (n=232) were male. The majority of surveyees classified breast reconstruction as a cosmetic surgery, even when provided with a reconstructive cue (n=243, 66.8%). Compared to breast augmentation, breast reconstruction was rated more attractive (p <0.0005), with higher impact on self-esteem (p<0.001), and more willing by the public to be covered by health insurance (p <0.0001). Similarly, breast reduction, rhinoplasty, and blepharoplasty were viewed more favorably by the public when presented as a reconstructive or restorative cue versus a cosmetic cue. The exception was gynecomastia, for which the public rated the cosmetic cued case as more attractive (p<0.05). On linear regression, there was a significant positive correlation between reconstructive cues and insurance coverage (p value 0.0003), and reconstructive cues and willingness to pursue (p value <0.05).
CONCLUSIONS: Our study of public opinions on cosmetic or reconstructive/restorative cued PRS cases, reveals the following: 1. There is greater public support for reconstructive/restorative cued PRS cases over cosmetic cued ones, 2. Misconceptions of breast reconstruction as a cosmetic procedure persist, 3. Results of procedures with reconstructive cues (Figure 2) are perceived to be more cosmetically improved than those with cosmetic cues. 
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