Anticipating benefits and decreasing burdens: the responsibility inherent in pediatric plastic surgery.

Working with child patients and their families in the practice of plastic and reconstructive surgery is rewarding and risky. Technical training is understandably intensive. However, the importance of the work that is needed before an operation does not always attract the same attention. Surgery that is done to change a child's body results in a change in that person's identity and cannot be taken lightly. A review of the overall benefit and burden of both the untreated condition and the proposed changes must be considered to support a change so that it does not damage an individual's identity development. By taking the time to understand what the patient's perspective is, surgical change can become a process that a person is part of, instead of it being something that is done to them. This helps to set up a situation where the change will be directly beneficial to the patient, and that change will be sustained over a long period. When evaluating surgical options with children, the influences and pressures that exist within families and throughout society must also be considered. A young child and his/her future must not get lost in the difficult negotiations between parents/guardians, surgeons, and society. By taking more time to consider the tremendous meaning that your work has outside the operating room and in the context of who the patient is becoming, you will have a greater chance of not just enhancing someone's appearance, but also improving his/her quality of life.