Microsurgery has been the basis of a wide range of technical developments in plastic surgery for over 3 decades. Microsurgery is the basis for the practices of replantation and peripheral never surgery that has redefined a number of clinical problems including thumb and mandible reconstruction. In the immediate future, microsurgery may make significant contributions to plastic surgery infrastructures, contributions that may help redefine reconstructive plastic surgery. These developments may be as significant as ongoing technical progress. This article explores the potential contributions of microsurgery to the infrastructures of patient population definition, practice economics, academic organization, and medical education.