Here at Stanford the ratio tilts heavily toward reconstructive. I would say my own practice, for example, is 90 percent reconstructive and 10 percent cosmetic. The development of muscular flaps and free flaps. In breast reconstruction, we can now use autologous tissue in many cases, avoiding the need for implants. In a tram flap, you take part of the rectas muscle and skin from the lower abdomen and tunnel it up to the area of the breast and reshape it to look just like a breast.
Patients end up with just a little horizontal scar in the bikini line.
These kinds of flaps, moving muscles around and hooking up the blood vessels from one part of the body to the other, have broad application but they come out of plastic surgery. Previously, surgeons could do a crude flap by rotating a piece of skin in the local area to cover a defect. But if you needed more than that, it wasn't available. The best we could do were skin grafts. These kinds of flaps have saved people from requiring amputations because of infections from open wounds.