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Plastic surgery Content Supplied by NHS Choices
Introduction

Plastic surgery is the branch of surgery specialising in repairing and reconstructing missing or damaged tissue and skin, usually because of surgery, illness, injury or an abnormality present from birth.

The main aim of plastic surgery is to restore the function of tissues and skin to as close to normal as possible. Improving the appearance of body parts is an important, but secondary, aim.

Plastic surgery is different to cosmetic surgery, which is surgery carried out solely to change a healthy person's appearance to achieve what they feel is a more desirable look. There are separate pages on cosmetic surgery.

When plastic surgery is used

Plastic surgery can be used to repair:

  • abnormalities that have existed from birth, such as a cleft lip and palate, webbed fingers and birthmarks
  • areas damaged by the removal of cancerous tissue, such as from the face or breast
  • extensive burns or other serious injuries, such as those sustained during traffic accidents

Plastic surgery can also help a person recover their self-esteem and confidence following surgery.

Read more about why plastic surgery is used.

Availability of plastic surgery

Plastic surgery for reconstructive purposes is usually carried out free of charge on the NHS. However, availability can vary around the country and is determined by local clinical commissioning groups (CCGs).

Plastic surgery is performed by plastic surgeons with extensive training who belong to professional associations, such as the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS).

Most people are referred to NHS plastic surgeons by their GP or a specialist consultant they see about their condition.

Plastic surgery is also available privately, but can be very expensive. It's still a good idea to speak to your GP or specialist first if you're considering private treatment, even if a referral isn't required.

Plastic surgery techniques

Plastic surgery uses a wide range of reconstructive techniques, but the main ones are:

  • skin grafts - where parts of healthy skin from an unaffected area of the body are removed and used to replace lost or damaged skin
  • skin flap surgery - where a piece of tissue from one part of the body is transferred to another, along with the blood vessels that keep it alive; it's called flap surgery because the healthy tissue usually remains partially attached to the body while it is repositioned
  • tissue expansion - surrounding tissue is stretched to enable the body to "grow" extra skin, which can then be used to help reconstruct the nearby area

As well as these main techniques, plastic surgeons use a wide range of other methods, such as fat transfer or grafting (where fat is removed from one area and inserted in another area, usually to correct unevenness), vacuum closure (where suction is applied to a wound through a sterile piece of foam to draw out fluid and encourage healing), camouflage make-up or cream, and prosthetic devices, such as artificial limbs.

Read more about how plastic surgery is performed.

Risks of plastic surgery

As with any type of surgery, there are risks and complications associated with plastic surgery. The degree of risk will depend on a number of factors, including whether the surgery is to a small or large area of tissue and the overall health of the person having the procedure.

Some procedures carry specific risks, but general risks include:

  • pain and discomfort
  • infection
  • scarring
  • the failure of the repaired area of skin, due to a restricted blood supply

Read more about the possible complications of plastic surgery.


Why plastic surgery is used

Plastic surgery can be used to correct defects present from birth or to repair skin and tissue damage caused by disease, illness or injury later in life.

It can also improve a person's confidence, self-esteem and overall quality of life.

There are many different situations where plastic surgery may be needed, and a variety of surgical procedures can be used. Some of the most common reasons why it's carried out are outlined below.

Conditions present from birth

Plastic surgery can be used to correct defects present at birth (congenital defects), including:

  • cleft lip and palate - a birth defect affecting the top lip and the roof of the mouth (palate)
  • birthmarks, including port wine stains and haemangiomas - these are caused by problems with blood vessels
  • craniosynostosis - a rare problem with the skull that causes a baby to be born with an abnormally shaped head
  • hypospadias - the opening of the urethra in boys (the tube that carries urine out of the body) is on the underside of the penis
  • ear problems - such as very small or absent ears (microtia)
  • hand problems - such as having webbed fingers or too many or too few fingers

Conditions that develop later in life

Plastic surgery can also be used to repair and reconstruct damaged tissue caused by problems that develop later in life (acquired problems), such as:


How plastic surgery is performed

Plastic surgery can involve a number of different techniques to move and manipulate body tissue.

Before having plastic surgery, you should have a consultation with a plastic surgeon. They will explain in detail what will happen before, during and after surgery. You may also be given a psychological assessment.

Plastic surgery used to be confined to a procedure called a skin graft, but newer techniques such as tissue expansion and flap surgery are often used these days. These techniques are discussed in more detail below.

Skin grafts

A skin graft is a surgical procedure where healthy skin is removed from an unaffected area of the body and used to cover lost or damaged skin.

Skin grafts may be used for bone fractures that break the skin (open fractures), large wounds, surgical removal of an area of the skin (for example, because of cancer) and burns.

There are two main types of skin graft:

  • a full thickness skin graft - the top layer of skin (epidermis) and all the layers of skin underneath (dermis) are removed and the area is closed with stitches; only a small area of skin will be removed, usually from the neck, behind the ear or the inner side of the upper arm
  • a partial or split thickness skin graft - the epidermis and a smaller part of the dermis are removed, and the area is left to heal without being closed by stitches; the skin is usually taken from the thigh, buttock or upper arm

Before the procedure, you'll be given a general anaesthetic or a local anaesthetic. This will depend on the size and location of the affected area.

The skin graft will usually be held in place using stitches, staples, clips or special glue. The area will be covered with a sterile dressing until it has connected with the surrounding blood supply, which usually takes around five to seven days.

A dressing will also be placed over the area where the skin has been taken from (the donor site) to help protect it from infection. The donor area of partial thickness skin grafts will usually take about two weeks to heal. For full thickness skin grafts, the donor area only takes about 5 to 10 days to heal, because it's normally quite small and closed with stitches.

At first, the grafted area will appear reddish-purple, but it should fade over time. It can take a year or two for the appearance of the skin to settle down completely. The final colour may be slightly different to the surrounding skin, and the area may be slightly indented.

Tissue expansion

Tissue expansion is a procedure that encourages the body to "grow" extra skin by stretching surrounding tissue. This extra skin can then be used to help reconstruct the nearby area.

Examples of when tissue expansion may be used include breast reconstruction and repairing large wounds.

The technique involves inserting a balloon-like device called an expander under the skin near the area to be repaired. This is then gradually filled with salt water over time, causing the skin to gradually stretch and grow.

The operation to insert the expander is usually carried out under general anaesthetic.

The time involved in tissue expansion can vary, and largely depends on the size of the area to be repaired. If a large area of skin is involved, it can take as long as three or four months for the skin to grow enough. During this time, the expander will create a bulge in the skin.

Once the skin has expanded sufficiently, a second operation is needed to remove the expander and reposition the new tissue.

This technique ensures that the repaired area of skin has a similar colour and texture to the surrounding area. There is also a lower chance of the repair failing (see complications of plastic surgery for more information) because the blood supply to the skin remains connected.

Flap surgery

Flap surgery involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessels that keep it alive.

Flap surgery may be used for a variety of reasons, including breast reconstruction, open fractures, large wounds and improving cleft lip and palates.

In most cases, the skin remains partially attached to the body, creating a "flap". The flap is then repositioned and stitched over the damaged area.

Occasionally, a technique called a free flap is used. This is where a piece of skin, and the blood vessels supplying it, are entirely disconnected from the original blood supply and then reconnected at a new site. A technique called microsurgery (surgery using a microscope) is used to connect the tiny blood vessels at the new site.

Depending on the location and size of the flap, the operation can be carried out under general or local anaesthetic.

As flap surgery allows the blood supply to the repaired area to be maintained, there is a lower risk of the repair failing compared to a skin graft.


Complications of plastic surgery

As with any type of surgery, plastic surgery has associated risks and complications.

The degree of risk depends on whether the surgery is in a small or large area, the surgeon's level of experience and the overall health of the person having the procedure.

Complications from plastic surgery can include:

  • pain and discomfort - which may require painkillers for a few days
  • bleeding - which may require a blood transfusion if severe
  • infection - which may require antibiotics or further surgery
  • scars - you will have scars where incisions were made during surgery, although these will usually fade over time
  • implant failure - if an implant is used during plastic surgery, there is a chance that this could leak and change shape, in which case further surgery may be needed to replace it
  • skin graft or flap failure - a skin graft or flap can die if the blood supply to the area is restricted; if this happens, further surgery will be needed to remove it before you can have reconstructive surgery again

You should discuss with your surgeon the risks associated with your particular type of plastic surgery.

If you have any concerns regarding your recovery from a surgical procedure, such as pain, swelling, discharge or any other unexpected side effects, speak to your surgeon, GP or healthcare team immediately.


 
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