Plastic surgery

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

Contents

Introduction

Plastic surgery is the branch of surgery specialising in repairing and reconstructing missing or damaged tissue and skin, usually due to 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, objective of plastic surgery.

When plastic surgery is used

Plastic surgery can be used to repair:

  • abnormalities caused by birth defects, 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 motor vehicle accidents

Plastic surgery can also help a person recover their self-esteem and confidence following surgery for an abnormality that has existed from birth (congenital abnormality), an injury or illness.

Read more about why plastic surgery is used.

Plastic surgery techniques

Plastic surgery uses a great range of techniques, depending on the condition being treated. There are three main groups of reconstructive methods:

  • skin grafts - a procedure that transfers parts of healthy skin from an unaffected area of the body to replace lost or damaged skin, relying on the grafted area to keep the graft alive
  • skin flap surgery - a procedure that 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; it is called flap surgery because the healthy tissue usually remains partially attached to the body while it is repositioned
  • tissue expansion - a procedure that enables the body to 'grow' extra skin by stretching surrounding tissue, this extra skin 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 vacuum closure (where suction is applied to the wound through a sterile piece of foam to help encourage better healing), camouflage make-up or cream and prosthetic devices (for example, artificial limbs).

Read more about how plastic surgery is performed.

Risks

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, the surgeon's level of experience and the overall health of the person having the procedure.

Some procedures carry specific risks, but general risks include infection, scarring and the failure of the repaired area of skin due to a restricted blood supply.

Read more about the possible complications of plastic surgery.

Access to 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 commissioning groups (CCGs).

Complications

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 level of experience of the surgeon and the overall health of the person having the procedure.

Complications from plastic surgery can include:

  • bleeding, which may require a blood transfusion if severe
  • pain and discomfort, which may require painkillers for a few days
  • 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 - the 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, doctor or healthcare team immediately.

How it 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 that removes healthy skin from an unaffected area of the body and covers the 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, due to cancer), burns and cleft lip and palates.

There are two main types of skin graft:

  • a full thickness skin graft – where 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 – where 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, depending on the area being treated.

You may be able to go home on the same day as the procedure, or you may need to stay in hospital. It 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 healed and has connected with the surrounding blood supply. This will usually take 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 takes about five days to heal.

After having a skin graft, it's common to feel more discomfort in the area that the skin was taken from rather than in the skin graft. Painkillers may be recommended to help ease any pain and discomfort.

When you return home, you'll be advised to rest affected areas as much as possible to help them heal properly. Depending on the location of the skin graft and the type of work you do, you may be advised to take time off work.

Tissue expansion

Tissue expansion is a procedure that enables 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, causing the skin to stretch and grow over time.

The operation to insert the expander can be carried out under general or local 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.

Why it is necessary

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

There are many different situations where plastic surgery may be needed, and a variety of surgical procedures can be used.

Conditions present from birth

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

  • cleft lip and palate - a birth defect that affects the top lip and the roof of the mouth (palate)
  • birthmarks, including port wine stains and haemangiomas - these are caused by malformations of capillaries, veins and arteries
  • 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 (the tube that carries urine from the bladder to the penis) is on the underside of the penis

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, such as:

  • cancer - to repair the skin or improve appearance after the removal of cancerous tissue from places such as the breast or face
  • trauma - to repair damage to tissue caused by things such as severe fractures that break the skin, or a severe wound (for example, from an animal bite)
  • infection - to remove dead tissue and repair the surrounding area
  • extensive burns - to repair damaged skin and improve its appearance
  • other conditions - such as osteoarthritis, rheumatoid arthritis, carpal tunnel syndrome, venous ulcers, pressure ulcers and facial palsy (such as Bell's palsy).

Self-esteem

As well as repairing the physical damage caused by injury and illness, reconstructive surgery can also improve a person’s confidence, self-esteem and overall quality of life.

Read more about how plastic surgery is performed.

Content supplied by NHS Choices