Plastic and Reconstructive Surgery in Sports Medicine: Interdisciplinary Intersections, Clinical Management, and Optimization of Return to Play (RTP) - a narrative review

Background: Modern high-velocity athletics and collision disciplines have increased the incidence of complex trauma and biomechanical dysfunctions. Beyond conventional orthopediccare, plastic and reconstructive surgery plays an essential role: restoring anatomy after injury and optimizing body mechanics for performance. Aim: To summarize current evidence on plastic, aesthetic, and reconstructive surgery in athletes, emphasizing functional biomechanics, exercise performance, and safe return to play (RTP). Material and methods: A structured literature search of major databases (PubMed, Scopus, Cochrane Library, Google Scholar; prioritizing 2016–2026) was performed using MeSH terms related to plastic surgery, sports trauma, and athletic performance. Results: Patient-specific 3D-printed carbon-fiber orthoses for craniomaxillofacial fractures expedite safe and full RTP in rugby players, from 8-12 weeks to 2–3 weeks post-fixation. Early orthoplastic microvascular flap coverage and anatomical tendon re-anchoring (e.g., flexor digitorum profundus avulsion repair within 7–10 days) preserve joint kinematics and lower complication rates. Functionally, reduction mammaplasty provides significant gains in VO2max, running economy, and spinal posture alignment. Subfascial, subpectoral or dual-plane pocket method of breast augmentation are preserving pectoralis major strength, however subfascial approach prevents animation deformities. In bodybuilders with AAS-induced gynecomastia, open intra-areolar adenectomy with liposuction effectively removes dense fibrotic parenchyma, though elevated bleeding risks require strict perioperative care. Functional labiaplasty resolves saddle-induced chafing in 86,2% of female participants. Conclusions: Plastic surgery provides essential anatomical restoration and functional optimization in sports medicine. Individualized, criterion-based RTP protocols minimize complications and expedite safe clearance.