Financial Toxicity in Plastic Surgery: A Scoping Review

Financial toxicity (FT) describes the physical, psychosocial, and financial burden of health care-related costs on patients' well-being. Plastic surgery patients may be susceptible to FT due to high procedure and adjunct therapy costs. Despite these risks, FT resulting from plastic and reconstructive surgery remains unclear. This scoping review assessed the prevalence and impact of FT on plastic surgery patients.

MEDLINE, Embase, Web of Science Core Collection, Scopus, and the Cumulative Index to Nursing and Allied Health Literature were searched from inception through February 17, 2026, for studies evaluating FT in plastic surgery. At least 2 reviewers independently screened records and performed data extraction. Findings were synthesized narratively. Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews guidance.

Of the 4213 studies screened, 14 studies were included in the review. All included studies incorporated cross-sectional survey data, most commonly evaluating breast reconstruction (n = 8, 57.14%). Greater FT was most consistently associated with socioeconomic vulnerability, including lower household income and less favorable insurance or financial circumstances, while treatment-related associations varied across clinical contexts. FT was characterized by out-of-pocket expenses, financial decline, debt, employment-related consequences, and reductions in household spending. Greater FT was also associated with poorer psychosocial well-being, quality of life, and symptom burden. Coping behaviors included use of savings or credit, reductions in essential and nonessential spending, and changes in health care use or treatment timing.

FT among patients receiving plastic surgical care extended beyond direct out-of-pocket expenses to broader financial and psychosocial consequences. Socioeconomic vulnerability was most consistently associated with greater FT, while treatment-related associations varied across clinical contexts. Future prospective studies should evaluate financial-needs screening, cost-informed counseling, and financial navigation as potential strategies to reduce FT and improve cost understanding and treatment decision-making.