Reconstructive and restorative cues improve public perception on the value of plastic and reconstructive surgeries

Published:April 21, 2021DOI:



      Persistent public misconceptions of plastic and reconstructive surgery (PRS), ambiguity between cosmetic versus reconstructive surgical procedures, and subjective interpretation of aesthetics can result in undervaluing of the field. Our study analyzes how patient context (cosmetic or reconstructive/restorative cues) affect public perception of outcomes and value of surgery.


      We distributed Qualtrics™ surveys to laypersons via Amazon Mechanical Turk. Demographics were self-reported. The survey presented a series of pre- and post-operative photographs of PRS surgeries alongside either a cosmetic or reconstructive/restorative cue, followed by questions on values of procedure. Survey responses were analyzed using two-tailed Student's t tests and chi square analyses, univariate and multivariate analysis, and linear regression.


      Of the 459 respondents, the mean age was 38.5 ± 12.1 years, and was 50.5% (232) male. The majority of respondents classified breast reconstruction as a cosmetic surgery (243, 66.8%), and was rated more attractive (p < 0.0005), higher impact on self-esteem (p < 0.001), and to be covered by health insurance (p < 0.0001) compared to breast augmentation. Reconstructive cued breast and facial procedures were viewed more favorably; the exception was gynecomastia reduction. Reconstructive classification had significant positive correlation with support for insurance coverage (R2 = 0.8268) and willingness to pursue (R2 = 0.5328).


      This study revealed more public support for reconstructive/restorative cued PRS cases over cosmetic cued PRS cases, and persistent misconceptions of breast reconstruction as a cosmetic procedure. Reconstructive or restorative cues can be used to educate the public and address skewed perceptions on the roles and value of PRS.


      To read this article in full you will need to make a payment


        • De Blacam C.
        • Kilmartin D.
        • Mc Dermott C.
        • Kelly J.
        Public perception of plastic surgery.
        J Plast Reconstr Aesthetic Surg. 2015; (Published online)
        • Dunkin C.S.J.
        • Pleat J.M.
        • Jones S.A.M.
        • Goodacre T.E.E.
        Perception and reality–A study of public and professional perceptions of plastic surgery.
        Br J Plast Surg. 2003; (Published online)
        • Widgerow A.D.
        Plastic surgery–more than just a nip and tuck.
        S Afr Med J. 1994; (Published online)
        • Di Stefano N.
        The idea of beauty and its biases: critical notes on the aesthetics of plastic surgery.
        Plast Reconstr Surg - Glob Open. 2017; (Published online)
        • Persichetti P.
        • Barone M.
        • Cogliandro A.
        • Di Stefano N.
        • Tambone V.
        Can philosophical aesthetics be useful for plastic surgery? The subjective, objective and relational view of beauty.
        J Plast Reconstr Aesthetic Surg. 2019; (Published online)
        • Pommier E.A.
        The compassion scale.
        Diss Abstr Int Sect A Humanit Soc Sci. 2011; (Published online)
        • Neff K.D.
        • Pommier E.
        The relationship between self-compassion and other-focused concern among college undergraduates, community adults, and practicing meditators.
        Self Identity. 2013; (Published online)
        • Neff K.D.
        Self-compassion scale.
        Self Identity. 2003; (Published online)
        • Fraser S.J.
        • Al Youha S.
        • Rasmussen P.J.
        • Williams J.G.
        Medical student perception of plastic surgery and the impact of mainstream media.
        Plast Surg. 2017; (Published online)
        • Kim D.C.
        • Kim S.
        • Mitra A.
        Perceptions and misconceptions of the plastic and reconstructive surgeon.
        Annals of plastic surgery. 1997
        • Rosenthal E.
        • Clark J.M.
        • Wax M.K.
        • Cook T.A.
        Emerging perceptions of facial plastic surgery among medical students.
        Otolaryngol - Head Neck Surg. 2001; (Published online)
        • Rowsell A.R.
        The place of plastic surgery in the undergraduate surgical curriculum.
        Br J Plast Surg. 1986; (Published online)
        • O'Donnell C.A.
        Variation in GP referral rates: what can we learn from the literature?.
        Fam Pract. 2000; (Published online)
        • Plastic Surgery in the British Isles Present and Future
        The British Association of Plastic Surgeons, Royal College of Surgeons, London Br Assoc Plast Surg.
        1994 (Published online)
        • Fan K.L.
        • Graziano F.
        • Economides J.M.
        • Black C.K.
        • Song D.H.
        The public's preferences on plastic surgery social media engagement and professionalism: demystifying the impact of demographics.
        Plast Reconstr Surg. 2019; (Published online)
        • Kipling M.
        • Ralph J.E.M.
        • Callanan K.
        Psychological impact of male breast disorders: literature review and survey results.
        Breast Care. 2014; (Published online)
        • Midding E.
        • Halbach S.M.
        • Kowalski C.
        • Weber R.
        • Würstlein R.
        • Ernstmann N.
        Men With a “Woman's Disease”: stigmatization of male breast cancer patients—a mixed methods analysis.
        Am J Mens Health. 2018; (Published online)
        • Skop M.
        • Lorentz J.
        • Jassi M.
        • Vesprini D.
        • Einstein G.
        Guys Don't Have Breasts”: the lived experience of men who have BRCA gene mutations and are at risk for male breast cancer.
        Am J Mens Health. 2018; (Published online)
        • Wang Q.-.X.
        • Bai Y.
        • Lu G.-.F.
        • Zhang C.-.Y.
        Perceived health-related stigma among patients with breast cancer.
        Chinese Nurs Res. 2017; (Published online)
        • Ernst J.
        • Mehnert A.
        • Dietz A.
        • Hornemann B.
        • Esser P.
        Perceived stigmatization and its impact on quality of life - results from a large register-based study including breast, colon, prostate and lung cancer patients.
        BMC Cancer. 2017; (Published online)
        • Saxena P.
        Trading and managing stigma: women's accounts of breast implant surgery.
        J Contemp Ethnogr. 2013; (Published online)
        • Saxena P.
        Trading and managing stigma.
        J Contemp Ethnogr. 2013; (Published online)
        • Rodriguez-Garcia R.
        • Frazier L.
        Cultural paradoxes relating to sexuality and breastfeeding.
        J Hum Lact. 1995; (Published online)
        • Goddu A P.
        • O'Conor K.J.
        • Lanzkron S.
        • et al.
        Do words matter? Stigmatizing language and the transmission of bias in the medical record.
        J Gen Intern Med. 2018; (Published online)
        • Motakef S.
        • Motakef S.
        • Chung M.T.
        • Ingargiola M.J.
        • Rodriguez-Feliz J.
        The cosmetic surgery stigma: an American cultural phenomenon?.
        Plast Reconstr Surg. 2014; (Published online)
        • Yarosh D.B.
        Perception and deception: human beauty and the brain.
        Behav Sci. 2019; (Published online)
        • Paolacci G.
        • Chandler J.
        • Ipeirotis P.G.
        Running experiments on Amazon mechanical turk.
        Judgm Decis Mak. 2010; (Published online)
        • Turk A.M.
        Amazon Mechanical Turk.
        2020 (Published 2020. Accessed)
        • Chandler J.
        • Shapiro D.
        Conducting clinical research using crowdsourced convenience samples.
        Ann Rev Clin Psychol. 2016; (Published online)
        • Arditte K.A.
        • Çek D.
        • Shaw A.M.
        • Timpano K.R.
        The importance of assessing clinical phenomena in Mechanical Turk research.
        Psychol Assess. 2016; (Published online)
        • Miller D.A.
        • Chollet J.A.
        • Goodwin T.M.
        Clinical risk factors for placenta previa-placenta accreta.
        Am J Obstet Gynecol. 1997; 177: 210-214
        • Goodman J.K.
        • Cryder C.E.
        • Cheema A.
        Data collection in a flat world: the strengths and weaknesses of mechanical Turk samples.
        J Behav Decis Mak. 2013; (Published online)
        • Kosara R.
        • Ziemkiewicz C.
        Do mechanical turks dream of square pie charts?.
        in: Proceedings of the conference on human factors in computing systems. 2010
        • Mortensen K.
        • Hughes T.L.
        Comparing Amazon's mechanical turk platform to conventional data collection methods in the health and medical research literature.
        J Gen Intern Med. 2018; (Published online)
        • Bardos J.
        • Friedenthal J.
        • Spiegelman J.
        • Williams Z.
        Cloud based surveys to assess patient perceptions of health care: 1000 respondents in 3 days for US $300.
        JMIR Res Protoc. 2016; (Published online)
        • Shapiro D.N.
        • Chandler J.
        • Mueller P.A.
        Using mechanical turk to study clinical populations.
        Clin Psychol Sci. 2013; (Published online)
        • Buhrmester M.
        • Kwang T.
        • Gosling S.D.
        Amazon's mechanical Turk: a new source of inexpensive, yet high-quality, data?.
        Perspect Psychol Sci. 2011; (Published online)
        • Hauser D.J.
        • Schwarz N.
        Attentive Turkers: mTurk participants perform better on online attention checks than do subject pool participants.
        Behav Res Methods. 2016; (Published online)
        • Berinsky A.J.
        • Huber G.A.
        • Lenz G.S.
        Evaluating online labor markets for experimental research:'s mechanical turk.
        Polit Anal. 2012; (Published online)