Here's my 2 cents and, since I'm sure iGap will contradict what I am about to say, I will again say that this in only my opinion.
My advice is to choose a program based on what you think they're going to teach you. A place that is hand heavy may be great for you if you're interested (we have community guys who do hand that never did a hand fellowship), or maybe you want to do mostly breast. Or maybe you want more cosmetic experience and the program you're interested in is more reconstructive. Some are more community oriented and some are more academic.
Maybe you want to eventually live in a certain area. People do choose based on geography so they can get a feel of the local environment and make some connections while they're doing their training.
Choosing a program based on reputation alone can be misleading. When I was in training, I rotated through a big name hospital/program for cosmetics since my program did not have much in the way of aesthetic surgery (which was fine with me since I don't do it and never wanted to). The residents I worked with were not very good. I found out that it was mostly because they never really got to operate that much as the attendings were doing the majority of the cases. I remember scrubbing a case with a recent graduate from that same big name program who was freaked out about taking out an infected tissue expander.
And lastly, a lot of what you will learn will be self driven. You will need to read, plan the surgeries, participate in conferences, go to clinic and see your post ops. That can be done at just about any program.
However, if your goal in life is to be chairman at UTSW after Dr. Rorich dies, then none of this will matter.
