Have you heard the one about military medical centers offering free cosmetic surgeries to keep the surgeons in practice for wounded warriors?

If so, you are not alone.

In 2004, several national publications published articles on the topic.  New Yorker Magazine reported: "Anyone wearing a uniform is eligible," Dr. Bob Lyons, the chief of plastic surgery at Brooke Army Medical Center, said recently, in his office in San Antonio. "It is true: Personnel in all four branches of the military and members of their immediate families can get face-lifts, nose jobs, breast enlargements, liposuction, or any other kind of elective cosmetic alteration, at taxpayer expense."

The article went on to say: "The benefit of offering elective cosmetic surgery to soldiers is more for the surgeon than for the patient," Lyons said. "If there's a happy soldier or sailor at the end of that operation, that's an added benefit, but that's not the reason we do it. We do it to maintain our skills"- skills that are critical, he added, "when it comes to doing reconstructive surgery on soldiers who have been wounded."

However, whether it was true then or not, it is not true now, said Col. Louis Walker, the chief of Plastic Surgery at Madigan Army Medical Center.

"Plastic surgeons do have to maintain their skill level," Walker said. "And the medical centers do perform cosmetic surgery.  However, there is a cost for these surgeries."

At Madigan the plastic surgery unit comprises three plastic surgeons, a chief nurse, an operating room technician, an NCO, and a secretary who handle about 800 cases a year.  The bulk of Walker's work includes post-mastectomy, gastric-bypass, post-bariatric reconstruction, and breast reductions.

Although they are allowed to do up to 20 percent cosmetic surgeries, last year only 4.5 percent of the total procedures performed were cosmetic, Walker said. He attributed this to the large patient base, lack of plastic surgeons, and an increase in the cost of some procedures.

"To have a successful plastic surgery business you need a client base of about 150,000 patients," he said. "The three surgeons at Madigan cover 23 states and have a patient base of about 3 million."

Additionally, with only 18 plastic surgeons Army wide, most facilities have a waiting list for procedures.  Reconstructive services come first, Walker said.

The number of cosmetic surgeries has decreased dramatically as well.  Walker attributed the decline to an increase in the mandated cost of the most sought after cosmetic surgery - breast augmentation.

Originally the cost of breast augmentation was $4,800, which was about $1,500 under the cost in the private sector, Walker said.  But when the cost was raised to $8,900 - $2,500 to $3,000 over the cost by a private provider - the military medical centers lost a lot of potential patients as well as the income that the surgeries brought in to the department.

"The money we received for breast augmentation was used to purchase new equipment and other things that we need in the department," Walker said. "We hope to get the cost of breast augmentations decreased again, so we can get the income back. It is money that is needed."