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DOD defends military's plastic surgery benefit

Article-DOD defends military's plastic surgery benefit

National report— Plastic surgery has a long and storied relationship with the U.S. armed forces. In fact, as Cosmetic Surgery Times reported in October 2003, plastic surgery as a specialty emerged out of the horrors of World War I. Now, in an ironic twist, the very institution that spawned the specialty and was essentially responsible for creating the demand for more and better techniques finds itself defending its provision for cosmetic surgery benefits.

The U.S. Department of Defense found itself on the defensive recently when an article in The New Yorker reported that all U.S. military personnel, as well as their dependents, are eligible for free cosmetic surgery. The article fueled a firestorm of media coverage that questioned whether the "perk" was being used to recruit servicemen and women, as well as whether providing free cosmetic surgery to military personnel on the taxpayers' dime is prudent.

More to the story It turns out that although it's true that active duty personnel may seek cosmetic surgery — which, along with all other military health benefits, is free — the surgeon must first get approval from the prospective patient's commanding officer, which reportedly is neither easy to obtain nor frequently granted. Furthermore, the surgery isn't free to dependents or to retired military personnel. While the cost to dependents and retirees is described as "nominal" in some places — such as on the Web site for the Facial Plastic Surgery Clinic at Walter Reed Army Medical Center, Washington, D.C. — nonetheless, there is a fee. And everyone eligible for this benefit, including active duty personnel, pays out of pocket for the implants used in solely cosmetic surgeries.

The DOD's defense Patricia A. Buss, M.D., a plastic surgeon and a captain in the Navy Medical Corps as well as deputy chief medical officer of the DOD's TriCare Management Activity, explains that the cosmetic surgery "perk" is actually for the surgeons — not the patients — and that prohibiting plastic surgeons from exercising the full range of their skills would make it difficult, if not impossible, to retain these surgeons in the military.

"We need to have plastic surgeons in the military, because we take care of soldiers, sailors, airmen and Marines who are injured and who have things like facial fractures, burns, chronic wounds and skin cancers," she says. "We also use our plastic surgeons to take care of people who have breast cancer, dog bites, cleft lip and so many other things. If we want to keep a cadre of well-trained plastic surgeons wearing uniforms and serving their country, we need to allow them to practice the full scope of care that comes within plastic surgery."

Similarly, Lt. Col. Joseph Legan, M.D., the Air Force Medical Service's chief consultant for surgical services, told Air Force Print News Today, "Air Force plastic surgeons, as with other specialists, require hours of education, training and continuous practice to keep their skills within medical standards. Without cosmetic surgery as part of their scope of practice, they would be deprived of experience in a fundamental part of their field."

Legan adds that the majority of cosmetic surgeries are done in conjunction with the training of surgical residents.

"This not only teaches skills but is a necessary part of training well-rounded surgeons who are every bit as good as their civilian counterparts in all aspects of their respective surgical specialty," he adds.

Cosmetic surgery is done on a space-available basis in the Air Force as well as in the other branches of the military, and, according to Legan, may constitute no more than 10 percent of an Air Force plastic surgeon's workload.

In the Navy Newsstand, Ellen Mauer of the Bureau of Medicine and Surgery Public Affairs reported that the Navy's plastic surgeons have been especially mission-oriented during Operation Iraqi Freedom, performing dozens of reconstructive operations for injured sailors and Marines being treated at facilities such as the National Naval Medical Center in Bethesda, Md.

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