ReshapeGuideReconstructive surgery: what it repairs and who pays
Updated
Reconstructive surgery rebuilds what injury, cancer, burns or a birth difference took away. Here's what each main type involves, how often it's done, what insurance usually covers and how to find the right team, with the voices of people who've been through it.
Short answer
Reconstructive surgery restores the function and appearance of a part of the body affected by injury, cancer, infection, burns or a difference present from birth. US plastic surgeons performed an estimated 1.28 million reconstructive procedures in 2025, most often wound repair, hand surgery and debridement, followed by breast reconstruction, according to the American Society of Plastic Surgeons. ASPS calls it medically necessary and says most health insurance plans cover it, though plans often require prior authorization.
Reconstructive or cosmetic?
The difference is the reason for the operation. Reconstructive surgery repairs something that disease, injury or development changed: a breast removed for cancer, a hand that can’t grip, a lip that didn’t join before birth. Cosmetic surgery reshapes features that are already healthy. Our guide to the types of plastic surgery covers the cosmetic side.
The line isn’t always sharp. Nose surgery can be purely cosmetic, or it can fix breathing after a broken nose. Eyelid surgery can freshen tired eyes, or lift lids that block your vision. Medicare flags several procedures as “sometimes (but not always) considered cosmetic” and usually wants prior authorization before paying for them:
- Eyelid surgery (blepharoplasty) removes drooping or excess eyelid tissue.
- Botulinum toxin injections treat muscle spasms and twitches. The same drug smooths wrinkles; see our guide to cosmetic injections for that side.
- Panniculectomy removes an apron of skin hanging over the abdomen. A tummy tuck is treated as cosmetic; our body contouring guide covers it.
- Nose surgery (rhinoplasty) changes the shape of the nose.
- Vein ablation closes off problem veins.
Private plans set their own rules, so ask yours. Either way, coverage turns on the documented medical reason, not the name of the operation.
Reconstructive surgery by the numbers
US plastic surgeons performed an estimated 1,282,735 reconstructive procedures in 2025, up 6% on 2024, according to the American Society of Plastic Surgeons (ASPS). Since its 2025 report, ASPS has based these figures on insurance claims from more than 3,000 board-certified plastic surgeons instead of a member survey, so they can’t be compared directly with older reports.
These count procedures, not people: one patient’s breast reconstruction can show up several times as it moves through its stages. They also reflect claims from plastic surgeons only, so hand surgery by orthopedic surgeons, for example, isn’t counted.
Breast reconstruction
Breast reconstruction rebuilds the shape of a breast after a mastectomy. There are two main ways to do it, and some people combine them. The comparison below follows the National Cancer Institute (NCI); the procedure counts are from ASPS.
| Implant-based | Flap (your own tissue) | |
|---|---|---|
| How it works | Usually a tissue expander first, swapped for an implant later; sometimes the implant goes in during the mastectomy | Skin and fat (sometimes muscle) moved from the belly, back, thighs or buttocks |
| Surgery and recovery | Shorter operation, little blood loss; recovery may be shorter | Longer operation, usually a hospital stay; a second scar where the tissue came from |
| If you need radiation | Immediate implant reconstruction is usually still possible if radiation comes after surgery; implants may not be an option if your chest has already had radiation | Usually done after radiation is finished, to replace damaged tissue |
| 2025 procedures | 32,207 expanders placed, 29,520 swapped for implants, 7,396 direct-to-implant, 35,586 implants placed on a separate day | 6,451 free flaps (DIEP and similar), 2,194 back (latissimus) flaps |
The DIEP flap, which uses skin and fat from the lower belly but no muscle, is the most common flap type, ASPS says. With implants, the expander is filled gradually over follow-up visits, and the chest is usually ready for the permanent implant 2 to 6 months after the expander was placed, according to NCI.
Timing. Reconstruction can start during the mastectomy (immediate) or after you’ve healed and finished treatment (delayed), even years later, NCI says. Radiation is one reason to wait: NCI says it can sometimes cause healing problems or infection in a reconstructed breast.
Revisions are common, ASPS says. About one in four breast reconstruction procedures in 2025 (38,990) was a revision to refine an earlier result. NCI says a nipple and areola can be re-created later if they weren’t kept during the mastectomy.
Going flat is an option. Some people decide not to rebuild. NCI says simply skipping reconstruction won’t give a flat closure (or aesthetic flat closure): the surgeon removes extra skin, fat and other tissue so the chest wall is smooth. External breast forms are another option, with or without a later decision to reconstruct.
NCI says people who have a mastectomy have varying degrees of numbness in the breast, because nerves are cut during surgery. Some feeling may return as the nerves regrow, and ASPS says plastic surgeons can reconnect nerves in the chest with a graft, which can restore some sensation. Ask your surgeon what to expect for the technique you’re considering.
Breast surgery for other reasons, like reductions, lifts and implants, is covered in our breast plastic surgery guide.
Hand surgery
Hand surgery was the fastest-growing reconstructive category in 2025, up 13% to 217,205 procedures by plastic surgeons alone. ASPS defines it as treating injuries and conditions that affect the strength, function or flexibility of the wrist or fingers, such as carpal tunnel syndrome, trigger finger and arthritis. The American Board of Medical Specialties (ABMS) adds ganglion cysts, fractures, and cut tendons and nerves.
According to ABMS, hand surgeons may be plastic, orthopedic or general surgeons. What they share is additional training in the hand, which can lead to a subspecialty certificate in surgery of the hand. ABMS says that training covers rehabilitative care as well as surgery, so ask whether your recovery will include hand therapy.
Skin cancer and Mohs reconstruction
After Mohs surgery, which removes the cancer layer by layer until the edges are clear, the American College of Mohs Surgery describes four options, depending on the size, depth and location of the wound:
- Let a small, simple wound heal on its own (called healing by secondary intention).
- Close a slightly larger wound with stitches, side to side.
- Cover a larger or more complicated wound with a skin graft from elsewhere on the body, or a flap of nearby skin.
- Occasionally, refer you to another reconstructive surgical specialist.
If your cancer is on your face, ask before the Mohs day who will repair the wound and when. One of the posts below describes nostril changes that took six months to settle. Facial work beyond the repair is covered in our facial plastic surgery guide.
Wounds, grafts and flaps
Repairs and debridement are the bulk of reconstructive surgery: together, more than 570,000 procedures in 2025. ASPS sorts them by how complex the wound is:
- Simple repair closes a wound with a single layer of stitches.
- Intermediate repair closes deeper wounds in layers, or contaminated wounds that need deeper cleaning.
- Complex repair is for severe wounds through several tissue layers, often after debridement.
- Adjacent tissue transfer moves a flap of nearby healthy tissue to cover the wound. At 158,064 procedures, it was the most common type of repair in 2025.
- Graft transplants living tissue, such as skin, from one part of the body to another.
- Free flap cuts tissue free from its blood supply and moves it to a distant spot, where NCI says its vessels are reattached using microsurgery. DIEP breast reconstruction is one example.
Cleft lip, palate and craniofacial surgery
About 1 in 1,030 US babies is born with a cleft lip (with or without a cleft palate), and about 1 in 1,560 with a cleft palate alone, according to the CDC. According to the American Cleft Palate-Craniofacial Association (ACPA), US cleft teams usually repair the lip at 10 weeks of age or older, and close the palate between 6 and 18 months, adjusting for the child’s health.
Surgery is only one part of the care. ACPA says every baby with a cleft should be seen by a team of specialists, and treatment can continue into adulthood. Its family guides cover hearing, speech and dental care alongside surgery, and later planned operations such as bone-graft surgery in the school years and lip, nose or jaw surgery in the teens. ACPA keeps a list of teams that meet its standards. Adults whose treatment stopped early can ask a team on that list whether it sees adult patients.
In ASPS’s definition, maxillofacial surgery (42,283 procedures in 2025) covers the jaw and face more broadly: repairing facial fractures and cuts, and jaw-straightening (orthognathic) surgery to help with speaking, chewing, swallowing or breathing.
Burns and scar revision
Burn care is the smallest category in the 2025 figures (4,673 procedures). For serious burns, the American Burn Association verifies burn centers and lists them on its site. Later reconstruction can include grafts and scar revision.
Scar revision, for scars from any injury or surgery, rose 20% in 2025 to 15,054 procedures. ASPS says it attempts to make a scar less visible so it blends in with the surrounding skin, and to restore movement where a scar restricts it. The aim is to minimize a scar, not erase it.
Lipedema
ASPS describes lipedema as a chronic condition in which fat builds up under the skin of the arms, legs, buttocks and hips. It counts liposuction for lipedema as reconstructive: 10,713 procedures in 2025, up 6%. ASPS gives the goals as relieving chronic pain, reducing limb swelling and improving mobility. Ask your surgeon and your plan what documentation coverage requires.
Insurance: what’s covered
ASPS says reconstructive surgery is considered medically necessary and is covered by most health insurance plans. In practice, coverage depends on your plan’s own definition, and what you can prove.
- Ask what your plan needs. Many plans require prior authorization: your surgeon’s office sends a request with documentation for approval before the procedure. That can include photos of the area.
- Get the reason in writing. Cleveland Clinic suggests having your surgeon write a letter and take photos detailing your case, so the functional problem (pain, blocked vision, loss of movement) is on record.
- Know your breast reconstruction rights. The Department of Labor says that under the Women’s Health and Cancer Rights Act, plans that cover mastectomies must cover every stage of reconstruction, surgery on the other breast so they match, breast forms, and treatment of complications like lymphedema. Your usual deductible and coinsurance can apply.
- Check if you’re on Medicare. Medicare.gov says Medicare doesn’t cover cosmetic surgery, but it covers surgery needed after an accidental injury or to improve the function of a malformed body part, and breast reconstruction after a mastectomy for breast cancer.
- Appeal a denial. HealthCare.gov says you can ask your insurer to reconsider (an internal appeal), and then take it to an independent reviewer (external review), so the insurer doesn’t get the final say. Medicare has its own appeals process; your denial notice explains the steps.
The Department of Labor says the law isn’t limited to cancer patients, so a preventive mastectomy for a BRCA mutation counts. Some church and government plans are exempt, and it doesn’t apply to Medicare or Medicaid. Medicaid coverage varies by state.
Finding the right surgeon or team
For most reconstruction, the right specialist depends on the body part. Start with the certification checks on our homepage, then:
- Breast reconstruction: ASPS points to board-certified plastic surgeons. NCI says free flaps need a surgeon experienced in microsurgery, so ask how many they do; for a flat closure, ask to see their results.
- Hands: ABMS lists a subspecialty certificate in surgery of the hand (the American Society for Surgery of the Hand has a finder). Ask whether you’ll have access to a hand therapist.
- Skin cancer: ask your Mohs surgeon who will repair the wound. For the nose, eyelids or lips, ask whether a plastic or facial plastic surgeon should do it.
- Clefts and craniofacial differences: ACPA recommends a team of specialists, not a single surgeon, and lists teams that meet its standards.
- Burns: for serious burns, the American Burn Association lists the burn centers it has verified; reconstruction can follow there or with a plastic surgeon.
Ask every surgeon how many of your exact procedure they do each year, what can go wrong, and whether further operations are likely; ASPS notes breast reconstruction can involve several revisions over time. Our plastic surgery checklist covers the rest, from checking the facility to planning recovery.
Recovery: what to expect
Cleveland Clinic says recovery depends on the procedure. Small procedures such as nipple reconstruction are outpatient, and some people are back at work or school right away. Flap surgery and other larger reconstructions may mean a night or more in hospital and several weeks off.
Three things come up across the sources:
- It’s often staged. ASPS describes expander, then implant, then revisions; ACPA describes lip repair as a baby, then palate, then a bone graft in the school years. Ask your surgeon to map out the whole sequence, not just the first date.
- Healing takes time. Cleveland Clinic says so, and NCI says complications of breast reconstruction can appear months or even years after surgery. Ask your surgeon when you’ll see the final result.
- Rehab can be part of the treatment. ABMS includes rehabilitative care in hand surgery training, and ACPA’s guides cover hearing, speech and dental care alongside cleft surgery.
After breast reconstruction, Cleveland Clinic says to contact your surgeon immediately about new skin changes, swelling, lumps, pain or leaking fluid. It notes other operations have their own warning signs, so ask your surgeon which ones apply to yours, and for a written recovery timeline before surgery.
The bottom line
Reconstructive surgery isn’t about looking different. It’s about getting back what an illness, injury or birth difference took. ASPS says most insurance plans cover it. It’s often done in stages, and each part of the body has its own specialists or team.
Check certification, ask how often the surgeon does your exact operation, get the insurance approval in writing, and plan for more than one step. Your own surgeon or care team should make the medical decisions with you; this guide is here to help you ask better questions.
In their own words
Reconstruction is rarely one operation with one doctor. These are real posts from people going through it, quoted word for word.
Breast reconstruction
3 posts
Now a candidate for a DIEP flap after radiation
“I was advised to wait and not do any permanent reconstruction until after radiation and healing (6+ months) as it can seriously effect the skin and potentially damage any reconstruction done prior. I am very happy I chose to wait.”
Chose not to rebuild the breasts
“I learned about flat closure and felt in my gut it was for me. … I am two months out from my double mastectomy with flat closure and it was right for me.”
Advice before a first surgical consult
“There are many reconstruction options, and it is not a one-and-done, in fact many of us need more than one surgery.”
Insurance
2 posts
On their surgeon photographing fat-graft areas before reconstruction
“It’s likely for insurance pre-authorization. … I also had a lot of pictures taken.”
Has lipedema; on surgery for it being treated as cosmetic
“Part of it has to do with the fact that it gets misinterpreted as an cosmetic issue instead of a medical one. Insurance, doctors, people around us believe we are getting these surgeries for cosmetic reasons instead of medical ones. … I’m going through those medical treatments to improve my mobility, pain and overall quality of life.”
Skin cancer
2 posts
After Mohs surgery and a small pedicle graft beside the nostril
“While the wound healed perfectly, it took a full 6 months for things to return to where they were before surgery.”
Mohs surgery on the nose, at least two years earlier
“The dermatologist did the skin cancer removal, and a plastic surgeon took a graft from between my beardline and my ear in the crease there to fill the removal site.”
Hands and burns
2 posts
On pressure garments after a burn
“I had a very similar hand burn, and I found the garments helped with nerve pain and tingling. I had to be convinced to stop wearing them after 18 months.”
On carpal tunnel release surgery
“Talk to a hand surgeon or orthopedist, and heed their advice. … It’s a 20-minute outpatient procedure, really not bad.”
Cleft care
1 post
To a parent whose 21-year-old son never finished cleft treatment
“Call the cleft team/craniofacial team at the local children’s hospital and ask for some help. They usually have an orthodontist as part of their team.”
Questions people ask
What is the most common reconstructive surgery?
Wound repair. In 2025, US plastic surgeons performed an estimated 367,880 repair procedures, from simple stitching to moving nearby tissue over a wound, according to the American Society of Plastic Surgeons. Hand surgery came next (217,205, up 13%), then debridement, the removal of dead or damaged tissue from a wound (203,160), and breast reconstruction (159,140, up 10%).
What's the difference between plastic surgery and reconstructive surgery?
Reconstructive surgery is one half of plastic surgery; the other half is cosmetic surgery. But plastic surgeons aren't the only ones who do it. Hand surgeons, for example, may be general, orthopedic or plastic surgeons with extra training, according to the American Board of Medical Specialties, and the American College of Mohs Surgery says its surgeons are trained to repair the wound left after removing a skin cancer. What makes surgery reconstructive is its purpose: restoring function or normal appearance, not changing healthy features.
Is reconstructive surgery covered by insurance?
Usually, when your plan agrees it's medically necessary. Many plans require prior authorization, and Cleveland Clinic suggests having your surgeon write a letter and take photos detailing your case. Breast reconstruction after a mastectomy has extra protection: the Department of Labor says that under the Women's Health and Cancer Rights Act, group health plans and individual health insurance that cover mastectomies must cover every stage of reconstruction. Your deductible and coinsurance can apply, but no more than for other benefits. If a private plan denies a claim, HealthCare.gov says you can ask for an internal appeal and then an independent external review; Medicare has its own appeals process.
Can a surgery be both cosmetic and reconstructive?
Yes. Nose surgery can be cosmetic or can repair breathing after a broken nose, and eyelid surgery can be cosmetic or can lift lids that block your vision. Medicare usually asks for prior authorization before eyelid surgery, nose surgery, panniculectomy (removing a hanging apron of belly skin), botulinum toxin injections and vein ablation, because they're sometimes cosmetic. What decides coverage is the documented medical reason.
Do I have to have breast reconstruction after a mastectomy?
No. Some people choose a flat closure instead, in which, the National Cancer Institute says, the surgeon removes extra skin, fat and other tissue to leave a smooth, flat chest wall. Others use an external breast form, or wait and decide later: NCI says reconstruction can be done months or even years after a mastectomy. If you want a flat closure, ask the surgeon how many they do and to see their results.
Does insurance cover reconstruction after a preventive mastectomy?
Under federal law, yes, if your plan covers your mastectomy. The Department of Labor says nothing in the Women's Health and Cancer Rights Act limits its rights to cancer patients, so people who have a mastectomy because of a BRCA mutation get the same reconstruction coverage. Some church and government plans are exempt, and the law doesn't apply to Medicare or Medicaid.
When is cleft lip and palate repaired?
According to the American Cleft Palate-Craniofacial Association, US cleft teams usually repair a cleft lip at 10 weeks of age or older, and close a cleft palate between 6 and 18 months. Exact timing depends on the child's health. ACPA says some children need further planned operations, along with hearing, speech and dental care, through childhood and sometimes into adulthood.
How long is recovery from reconstructive surgery?
Cleveland Clinic says it depends on the procedure: some people are back at work or school right away, others need several weeks. Small procedures such as nipple reconstruction are outpatient, while larger ones may need a night or more in hospital. Some reconstructions happen in stages: with implant-based breast reconstruction, NCI says the chest is usually ready for the permanent implant 2 to 6 months after the tissue expander is placed. Ask your surgeon for a written timeline for your own procedure.
Sources
- American Society of Plastic Surgeons: 2025 Procedural Statistics Release (PDF, September 2026)
- National Cancer Institute: Breast Reconstruction After Mastectomy (updated December 2, 2025)
- U.S. Department of Labor: Your Rights After a Mastectomy (Women's Health and Cancer Rights Act)
- Medicare.gov: Cosmetic surgery coverage
- HealthCare.gov: Appealing a health plan decision
- American Cleft Palate-Craniofacial Association: Lip and palate surgery
- American Cleft Palate-Craniofacial Association: Introduction to cleft lip and palate
- American Cleft Palate-Craniofacial Association: About team care
- American College of Mohs Surgery: Reconstruction after Mohs surgery
- American Board of Medical Specialties: American Board of Plastic Surgery (subspecialties, including surgery of the hand)
- Cleveland Clinic: Reconstructive Surgery
- American Burn Association: Find a burn center
- CDC: About cleft lip and cleft palate
- American Society for Surgery of the Hand: Find a hand surgeon
About this guide
ReshapeGuide is an independent publisher run by Nicolas. He is not a doctor, nurse or surgeon. Guides explain how procedures, costs and recovery generally work, using public sources such as medical boards, specialty societies, the FDA and peer-reviewed research, which each guide lists and links.
Facts and prices were checked against the sources above on October 7, 2026. Patient quotes are public posts, copied exactly; prices and outcomes in them are the posters' own and weren't verified. This is general information, not medical advice: talk to a board-certified surgeon or your doctor about your own situation.
First published October 7, 2026 · Last updated October 7, 2026