Even plastic surgeons avoid low-paying reconstructive procedures, society warns

Even within the popular field of plastic surgery, a neglected area is reconstructive surgery. While new fees have recently been established for some reconstructive procedures, critics point out that they still lack recognition as essential medical care.

“Plastic surgery includes fields beyond aesthetics. These areas include trauma and reconstructive surgery. Still, institutional support remains inadequate,” said the Korean Society of Plastic and Reconstructive Surgeons (KSPRS) at a press conference on Tuesday at the Grand InterContinental Seoul Parnas Hotel in Gangnam-gu, Seoul.

Reconstructive surgeons acknowledged the new fee schedule for perforator flaps as a step forward, but emphasized that ongoing advocacy is essential to secure further improvements in systemic support.

A perforator flap is a reconstructive surgical technique that supplies blood flow to tissue via small vessels (perforators) that branch from an artery, like tree branches. Its advantage lies in preserving the tissue and function of the donor site (where the graft material is harvested) as much as possible, since it uses only small vessels.

Recognizing this, a new reimbursement rate for perforator flaps was recently established. The Ministry of Health and Welfare partially revised the “List of Health Insurance Covered and Non-Covered Procedures and Relative Value Scores for Covered Services” in August, establishing new fees for free flap procedures using perforators. These fees represent about a 30 percent increase over existing free-flap fees.

“Reconstructive surgery performed by plastic surgeons is not merely cosmetic reconstruction. The field has established itself as an area of public and essential healthcare,” said Professor Lee Won-jai from Severance Hospital, who serves as the KSPRS chairman. “It is significant that this has been recognized in terms of reimbursement rates.”

However, Lee noted that slow progress in system improvements stems from insufficient recognition of reconstructive surgery within plastic surgery.

Hong Jong-won, Director of Public Relations at KSPRS and plastic surgeon at Severance Hospital, said, “Many plastic surgery procedures are complex and physically demanding. Yet, fees are low. Collaborative surgeries are also difficult.”

Hong added that, due to low fees, PAs (Physician Assistants) were assigned late, making the physician strike period even more challenging, underscoring the urgent need for systemic and institutional support.

“A 30 percent fee adjustment is still not enough, considering the surgical difficulty,” Hong said. He called for a more detailed classification system for reconstructive plastic surgery under the National Health Insurance. “In the U.S., classification is detailed by wound size or surgical scope. Korea lacks this,” he noted.

It was also pointed out that, while plastic surgery is a popular specialty, there is a need to train specialists dedicated to the reconstructive field.

“Plastic surgery developed due to the importance of reconstruction,” said Park Ji-ung, Director of Training and Education at KSPRS and professor at SNU-SMG Boramae Medical Center. “Our mission is to produce specialists who improve the public quality of life. We do this without losing our identity as plastic and reconstructive surgeons.”

However, Park noted that the current training system faces significant obstacles in achieving advocacy goals for reconstructive care.

Park highlighted that advocacy should focus on emphasizing the importance of reconstructive plastic surgery in resident education and on securing institutional support, calling for urgent policy measures across training and specialist development.