In 1991 he developed a sliding scale from a survey that asked plastic surgeons their perceptions of whether their patientsâ€™ motivations for a breast reduction were reconstructive or cosmetic (Annals of Plastic Surgery, 1991). Years later, Schnur himself challenged insurance carriersâ€™ misuse of the scale and indicated that the scale should no longer be used as criteria for insurance coverage (Annals of Plastic Surgery, 1999). However, many insurance companies still use this sliding scale as a way to deny coverage for a breast reduction procedure.