Plastic surgery
Plastic surgery

Plastic surgery is used to repair and reconstruct missing or damaged tissue and skin.

The main aim of plastic surgery is to restore the function and appearance of tissues and skin to it's as close to normal as possible.

Improving the appearance of body parts is an important, but secondary, aim.

Plastic surgery is different from 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.

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 often help improve a person's self-esteem, confidence and overall quality of life.

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 Health Boards.

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 it 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 healthy skin from an unaffected area of the body is 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's repositioned
  • tissue expansion – where 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 techniques, plastic surgeons also use many 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
  • prosthetic devices, such as artificial limbs

Risks of plastic surgery

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

The degree of risk depends on the size of the affected area, 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:

  • pain and discomfort
  • bleeding
  • infection
  • scarring

Contact your surgeon, healthcare team or GP immediately if you have any concerns after surgery, such as unexpected pain, swelling, discharge, or other side effects.

How is it 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'll explain in detail what will happen before, during and after surgery. You may also be given a psychological assessment.

Skin grafts used to be the main type of plastic surgery, but newer techniques, such as tissue expansion and flap surgery, are now often used.

Skin grafts

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

They may be used for bone fractures that break the skin (open fractures), large wounds, or where an area of the skin is surgically removed - for example, due to cancer and burns.

There are 2 main types of skin graft.

Partial or split thickness skin graft

This is where a thin layer of skin (as thin as tissue paper) is shaved from an area that usually heals well, such as the thigh, buttocks or calf.

The donor area may look pink or lighter than your surrounding skin for a few months, depending on your skin tone, then leave a faint (hardly noticeable) scar.

Full thickness skin graft

This is where the full thickness of skin (the top layer and layers underneath) are removed and the area is directly closed.

Sites often used include the neck, behind the ear, the upper arm and groin.

Because this type of skin graft is thicker, picking up a new blood supply can be more difficult, so any dressing will be left in place for 5 to 7 days before being removed by the surgical team.

What happens

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 5 to 7 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 usually takes about 2 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 may appear red or purple, but it should begin to look more like your surrounding skin 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 from 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.

Under general anaesthetic, a balloon-like device called an expander is inserted under the skin near the area to be repaired.

This is gradually filled with salt water, causing the skin to stretch and grow.

The time it takes for the tissue to be expanded can vary, depending on the size of the area to be repaired.

If a large area of skin is affected, it can take as long as 3 or 4 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's also a lower chance of the repair failing 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.

It may be used for a variety of reasons, including breast reconstruction, open fractures, large wounds, and, in rare cases, for improving a cleft lip and palate.

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.

For more complex reconstruction, 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.

A free flap is often used when large areas of specific tissue types are needed for reconstruction.

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's a lower risk of the repair failing compared with a skin graft.

Specific conditions

For information about the specific treatments for conditions where plastic surgery is commonly used, see:

The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 15/09/2021 14:15:01