Plastic surgery is popularly known for its performance in body aesthetics. Also, its
area includes microsurgery, burn treatment, hand, and craniomaxillofacial surgery.
Due to the diversity of medical specialties, many of the procedures in which plastic
surgeons are trained are also performed by other specialists, which may justify the
population’s lack of knowledge concerning the rich plastic performance. For example,
we have rhinoplasty with correction of a deviated septum, a surgery that is also performed
by otolaryngologists. Since the areas of operation of plastic surgery are little known
by the general public and also by the medical public, there is a risk that plastic
surgeons, qualified in dealing with a vast range of clinical-surgical problems, are
forgotten and overlooked in cases that escape the aesthetic area, thus alienating
competent professionals and overloading professionals from other specialties.
Understand the comprehension that Brazilian medical students from different years
and faculties have of the clinical scope and plastic surgery operation areas.
The procedure for conducting the research was divided into two parts: first, the questionnaire
link was sent to the participants in which it contained the intentions of the project
and the Free and Informed Consent Term (FICT), asking students to contribute with
the participation in our study and, right after, started the questionnaire with the
clinical cases. At the end of 99 days with the link being released, the questionnaire
was closed; responses were verified on the Google Docs platform and counted. The questionnaire
was sent for the first time through social networks on 28/8/2019 and was circulated
until 051/01/2020 when we started analyzing the responses.
All research follows Resolution No. 510, of April 7, 2016, promulgated by the Ministry
of Health, which ensures ethics and respect for human dignity in scientific research.
Under this resolution, the work was submitted and approved by the Research Ethics
Committee of the Pontifícia Universidade Católica de Goiás, with the following number 3,517,269.
Considering the variables studied, 426 medical students responded to the questionnaire,
but two participants were excluded for not having marked the agreement field with
the Free and Informed Consent Term (FICT) and one participant for being under 18 years
old. Therefore, the sample was composed of 423 participants, most of whom were female
(69.5%). The age of the participants varied widely from 18 to 46 years. The mean age
was 22.23 years, with a standard deviation of 3.60. As for the age group, the interval
between 20 and 23 years was the predominant (60.3%).
Regarding the distribution of students across Brazilian territory, the present study
had the participation of all Brazilian states, except Espírito Santo. The Midwest
region stood out with 253 (59.8%), followed by the Southeast with 54 (12.7%) and the
North with 55 (13%). The state of Goiás was the most representative with 206 participation
Regarding the year attended by medical students, it was observed that the third year
comprised the majority, with 119 (28.1%) participants. The second year represented
21.5%, and the fourth year 19.8%. When grouping the participants by basic (first and
second year), clinical (third and fourth year), and internship (fifth and sixth year)
cycles, it was observed that 203 (48%) belonged to the clinical cycle, 130 (30.7%)
to the basic cycle and 91 (21.5%) to the boarding school.
In addition to the questions that addressed plastic surgery areas, other questions
were elaborated on acute pancreatitis and abdomen trauma to divert biased responses.
From the analysis of clinical cases, it is clear that students are familiar with the
action of plastic surgeons in the aesthetic field (as, for example, in the resolution
of “facial aging,” “reduction of breasts,” and “flapping ears”). In the question that
addressed facial aging, dermatology was the area most cited as apt for such an approach,
with 53.7%. Plastic surgery and aesthetics occupied the second and third place with
38.3% and 7.32%, respectively. Plastic surgeons were the professionals mentioned by
372 (87.95%) students as trained professionals to perform otoplasty, followed by pediatric
surgeons (5.43%) and otorhinolaryngologists (4.96%). As for the question on the theme
of facial surgery, plastic surgery was mentioned by 349 (82.5%) of the participants.
The dermatology area was remembered by 313 (74%) of the students as the most suitable
medical specialty for applying botulinum toxin for facial rejuvenation.
In the question about the treatment of deviated septum and aesthetic correction of
the nose, there was a predominance of otorhinolaryngologists (63.8%), followed by
plastic surgeons (33.3%), the most suitable to approach the case.
As for the issue that addressed the topic of breast reconstruction after breast cancer,
373 (88.2%) of the participants indicated the plastic surgeon as a professional capable
of performing the procedure. Mastology and oncology surgery were indicated by 37 (8.74%)
and 13 (3.07%) of the students, respectively. In the question about basal cell carcinoma,
there was a division of the answers regarding the medical specialties indicated for
the treatment, being dermatology (46.8%), cancer surgery (37.1%) and plastic surgery
(7.8%) as the most pointed out by the research participants. Regarding the evaluation
of the participation of plastic surgery as an area also indicated for the treatment
of fractures in the craniomaxillofacial complex, this was mentioned by 46 (10.9%)
of the students, with the maxillofacial surgeon being the most remembered by 342 (80.8
%) of academics. As for the question that addressed the health professional most apt
to intervene in cases of laceration of the palmar tendons, the orthopedist with 273
(64.5%) of the answers was the most mentioned by the participants. Then, general surgeons
(15.1%) and plastic surgeons (11.1%) were mentioned. The evaluation of the participation
of plastic surgery as an area indicated in the reparative treatment after burns was
made through the question about great loss of soft tissues after an accident with
high electrical tension. Students pointed out plastic surgeons as the most indicated
by 260 participants (61.4%), followed by orthopedists with 23.4% and vascular surgeons
with 7.8%. Relating the issues with themes that address the areas of plastic surgery
that are not linked to the aesthetic field, such as the craniomaxillofacial area,
and the cycle in which the participants were grouped, it was possible to observe that
among the 294 students of the basic cycle only 8 (2 , 72%) mentioned plastic surgeons
as indicated to intervene. Among the 203 students in the clinical cycle, 29 (14.3%)
pointed out plastic surgery as a specialty able to approach the case and 9 (9.9%)
of the total of 91 students at the boarding school mentioned plastic surgeons. Another
area of plastic surgery with little knowledge about the possibility of action is
microsurgery. In the present study, 29 (22.3%) of the basic cycle students indicated
the plastic surgeon for the treatment of laceration of the palmar tendons, followed
by 11.8% of the students of the clinical cycle and 3.3% of the students at the boarding
According to data from “Medical Demography 2018”, there are 6,304 plastic surgeons
in Brazil, and 2% of recent graduates have plastic surgery as their first medical
option1. Data from theSociedade Brasileira de Cirurgia Plástica(SBCP), Brazil disputes with the United States of America the first position in the
number of professionals. Such data reinforce the interest of undergraduate medical
students in the specialty2. However, the fact that Brazilian universities concentrate their curricula in general
clinical specialties, such as gynecology, pediatrics, and general surgery, may justify
the lack of knowledge about the plastic surgeon’s operation areas by academics.
According to SBCP, plastic surgery is the surgical specialty in charge of reconstructing
body structures that present changes in their shape or function. However, for the
lay population, knowledge about this specialty is restricted to its aesthetic application.
This fact can be reinforced from the media analysis involved with plastic surgery:
68.94% were classified as aesthetic, 21.33% as repairers, and 9.73% as not classifiable3.
It was expected that medical students, unlike the lay population, would have more
in-depth knowledge about this specialty. However, from the questionnaire analysis,
it is clear that Brazilian medical students also associate the plastic surgeon’s role,
mainly with the aesthetic area.
The work showed that students have adequate knowledge of plastic surgeons’ actions
in the aesthetic field. However, in situations considered more complicated, these
professionals are little remembered by academics. It was also observed that students
in more advanced stages in the medical course do not have greater knowledge about
plastic surgery fields.
1. Scheffer M, Cassenote A, Guilloux AGA, Biancarelli A, Miotto BA, Mainardi GM. Demografia
médica no Brasil 2018. São Paulo (SP): Departamento de Medicina Preventiva da Faculdade
de Medicina da USP (FMUSP)/Conselho Regional de Medicina do Estado de São Paulo (CREMESP)/Conselho
Federal de Medicina (CFM); 2018.
2. Fernandes JW. O ensino da cirurgia plástica na graduação em medicina no contexto da
realidade brasileira. Rev Bras Educ Méd. 2016;40(2):286-94.
3. Lima DSC, Mata FSR, Oliveira FCC, Zenaide PV, Ziomkowski AA, Meneses JVL. A cirurgia
plástica na mídia: o conceito da especialidade veiculado pelos meios de comunicação
impressos no Brasil. Rev Bras Cir Plást. 2015;30(1):93-100.
1 . Pontifical Catholic University of the Goiás, Department of Medicine, Goiânia,
2 . University of the Rio Verde, Department of Medicine, Aparecida de Goiânia, GO,
Corresponding author: Pedro Freire Guerra Boldrin, Rua Pedro Rattes Fernandes, 168, Setor Central, Rio Verde, GO, Brazil Zip Code:
75901-280. E-mail: firstname.lastname@example.org
Article received: May 10, 2020.
Article accepted: July 19, 2020.
Conflicts of interest: none