Before having plastic surgery, you will 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.
There are many situations in which plastic surgery might be used to treat birth defects or diseased or damaged skin and tissue. It is beyond the scope of this topic to provide details about every possible surgical procedure, but below are the details of how three common procedures in the UK are performed – cleft lip and palate, breast reconstruction and skin grafts.
Cleft lip and palate
A cleft lip and palate is the most common form of birth defect in the UK. The care and treatment of babies who are born with a cleft lip and palate is provided by a number of healthcare professionals, including orthodontists (specialist dentists who can help to correct the function and appearance of crooked teeth), ear, nose and throat (ENT) specialists, speech therapists and plastic surgeons.
Surgery to repair the lip is usually carried out when a child is three months old. The procedure involves making an incision on either side of the lip so that the lip can be pulled down and rotated to produce a more normal looking appearance, before it's stitched into place. After surgery, a small scar is usually visible, although the surgeon will try to line up the scar with the natural lines of the face to make it less noticeable.
Surgery to repair the palate is usually carried out when a child is six months old. The surgeon will take tissue from either side of the mouth and use it to rebuild the palate and join the muscles together. In some cases, additional surgery may be required to improve the function and appearance of the lips and mouth.
Breast reconstruction
About 40% of women who have had breast cancer have a mastectomy to prevent further cancer in the future. A mastectomy is a surgical procedure to remove the breast.
After a mastectomy, many women have reconstructive breast surgery. It aims to recreate a breast mound that matches the other remaining breast. The procedure is carried out by a reconstructive plastic surgeon, either at the same time as the mastectomy or at a later date.
There are two main types of reconstructive breast surgery:
- prosthetic – artificial implants are used to replace some or all of your breast tissue
- autogenous – a new breast is created using tissue taken from another part of your body
A combination of implant and body tissue is sometimes also used to create a new breast. The type of procedure that's best suited to you will depend on a number of factors, such as the size and shape of your remaining breast and which procedure you prefer.
Prosthetic and autogenous breast surgery are discussed in more detail below.
Prosthetic breast surgery
If you decide to have prosthetic breast reconstruction, the surgeon will make a cut (incision) in your skin between your ribcage and your chest (pectoral) muscle. The implant will be inserted through the incision and the surgeon will then move it into position.
Once the implant is in position, the incision will be closed using stitches. The implants that are used are sometimes expandable and can be enlarged over the course of three to six months to produce a breast of a specific size and shape.
Read more about breast implants.
Autogenous breast surgery
If you decide to have autogenous breast reconstruction, tissue will be removed from your back, buttocks or stomach area (abdomen) and used to create a new breast mound. The advantage of autogenous breast reconstruction is that a full-sized breast is created immediately. However, it will probably change shape and size slightly in the first few months after surgery.
Once the newly created breast has had time to settle down and has reached its final shape and size, the last stage of the process is to reconstruct and reposition the nipple.
Skin grafts
Skin damage and skin loss can occur after surgical procedures, burns or other serious injuries. 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.
There are two types of skin graft. They are:
- a full thickness skin graft – the top layer of skin (epidermis) and 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 part of the dermis are removed, and the area is left to heal over without being closed by stitches; the skin is usually taken from the thigh, buttock or upper arm
If you have a skin graft, 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.
Before the procedure, you'll be given a general anaesthetic or a local anaesthetic, depending on the area being treated.
If the skin graft is covering a small area, stitches will usually be used to hold it in place. For larger areas, the skin graft will be secured using clips or stitches. 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 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 the affected area as much as possible to let it heal properly. Depending on the location of the skin graft on your body and the type of work you do, you may be advised to take some time off work.
