Plastics Subspecialties and Most Commons

[hydro5]

Hi Everyone,

3rd year medical student here with a few questions for the plastics people:

1. Do most plastic surgeons specialize in one field (craniofacial, hand, breast, cosmetic, reconstruction) or do general plastic surgeons exist? Where do you think the trend is going?

2. Do most complete additional fellowships (microvascular, hand, etc) if they plan on doing mostly general plastics, just to have?

3. Bread and butter procedures, what would you say are the most common? Breast reductions, rhinoplasties, tumor excision?

4. And of course, what would you say is the worst thing about plastic surgery? (Gotta know to make a decision!) Foot ulcers, stigma, etc?

Thanks for all your help in advance!

---

Members don't see this ad.

 

[drpatelplasticsurgery]

Hi Everyone,

3rd year medical student here with a few questions for the plastics people:

1. Do most plastic surgeons specialize in one field (craniofacial, hand, breast, cosmetic, reconstruction) or do general plastic surgeons exist? Where do you think the trend is going?

2. Do most complete additional fellowships (microvascular, hand, etc) if they plan on doing mostly general plastics, just to have?

3. Bread and butter procedures, what would you say are the most common? Breast reductions, rhinoplasties, tumor excision?

4. And of course, what would you say is the worst thing about plastic surgery? (Gotta know to make a decision!) Foot ulcers, stigma, etc?

Thanks for all your help in advance!

1. from the programs at which i interviewed, the path of the graduates seemed split 50-50 between private practice and fellowship-bound.

2. see above

3. w/in academic plastics, breast redux is very common, as are tissue expander (TE) breast augmentation s/p mastectomy. some attendings seem to focus more on melanoma and tumor excision than others...

4. be willing to accept the incorrect public perception that plastics folks just do "cosmetic" (aesthetic) surgery. also, be willing to accept the fluctuations in revenue that occur in private practice w/ up- and downswings of the economy. at least in academics, be willing to deal w/ poor wound healers (diabetic foot ulcers, smokers, non-compliance, etc.)

 

[Raygun77]

if your institution has a spinal unit (as mine does), a big part of the service will likely be flaps for pressure sores.

 

[rongeur]

Hi Everyone,

3rd year medical student here with a few questions for the plastics people:

1. Do most plastic surgeons specialize in one field (craniofacial, hand, breast, cosmetic, reconstruction) or do general plastic surgeons exist? Where do you think the trend is going?

2. Do most complete additional fellowships (microvascular, hand, etc) if they plan on doing mostly general plastics, just to have?

3. Bread and butter procedures, what would you say are the most common? Breast reductions, rhinoplasties, tumor excision?

4. And of course, what would you say is the worst thing about plastic surgery? (Gotta know to make a decision!) Foot ulcers, stigma, etc?

Thanks for all your help in advance!

The last figure I saw was that less than 25% of graduating plastic surgery residents do a fellowship. This number seems odd until you realize that people tend to think of the big name programs with lots of integrated spots as the only programs, but there are a lot of small, formerly 2-year fellowship programs for people who have done 5-7 years of GS and have no interest in further training.

Traditionally you only needed fellowships in pediatric CF or hand. Now it seems like academic people doing micro need a micro fellowship for the credential even if they went to a program where they were in the top 5% of micro volume. Lame but I suppose credential creep is happening everywhere in medicine. It's still not as bad as ENT or ortho in terms of huge blocks of the field that simply aren't done by people without fellowships - CF guys still do free flaps (if they want), hand guys still do rhinoplasty (if they want).

I think the worst thing about plastics is being further down the referral chain. It puts you in a weak position. Increasingly primary surgeons find some way to funnel the profitable recon back to them (by doing it themselves or having a partner do it or something), whether or not they give the patient good results. Diffusion of techniques is part of the problem too, a lot of the recon techniques that only plastic surgeons used to know are getting incorporated into other specialty residencies.