Plastic Surgery — Procedure Guide, Recovery & Risks | MyMedicPlus

Plastic surgery is a broad surgical specialty concerned with the restoration, reconstruction, or alteration of the human body. It encompasses two principal domains: reconstructive surgery, which restores normal form and function impaired by cancer, trauma, burns, congenital deformity, or infection; and cosmetic (aesthetic) surgery, which improves or changes normal appearance according to patient preference. The specialty name derives from the Greek 'plastikos' (to mould or shape), reflecting its focus on form and function. Board-certified plastic surgeons hold specialist qualifications such as FRCS (Plast) in the UK, American Board of Plastic Surgery (ABPS) certification in the USA, or equivalent national board credentials, following 8–10 years of surgical training beyond medical school. Plastic surgery uses a comprehensive toolkit ranging from skin grafting and local flaps to microsurgical free-tissue transfer requiring vessel anastomosis under operating microscope magnification. Plastic surgery is a surgical specialty dedicated to the reconstruction, restoration, and alteration of the human body. It encompasses two broad domains: reconstructive plastic surgery — restoring form and function following trauma, cancer ablation, burns, and congenital anomalies — and aesthetic (cosmetic) plastic surgery — elective procedures to improve appearance. Reconstructive procedures include breast reconstruction after mastectomy, cleft lip and palate repair, hand surgery, microsurgical free flap reconstruction of complex defects, burns management, and facial reconstruction. Aesthetic procedures include rhinoplasty, blepharoplasty, rhytidectomy (facelift), breast augmentation, abdominoplasty, liposuction, and body contouring after massive weight loss. Plastic surgeons are trained in both reconstructive and cosmetic work, and the boundary between the two is often fluid — a breast reduction is both reconstructive (relieving musculoskeletal symptoms) and cosmetic (improving appearance). Plastic surgery uses specialised techniques including tissue expansion, skin grafting, local and regional flap reconstruction, and microsurgery to achieve results not attainable by other surgical specialties.

Reconstructive indications include post-mastectomy breast reconstruction using implants, tissue expanders, TRAM flaps, DIEP flaps, or LD flaps; skin cancer excision and local flap or graft closure; cleft lip and palate repair in neonates and infants; burn scar contracture release with skin grafting; hand surgery (tendon repair, nerve repair, Dupuytren's contracture release); head and neck cancer reconstruction with free flaps after oncological resection; and lower limb trauma reconstruction. Cosmetic indications include rhinoplasty (nose reshaping), facelift (rhytidectomy), blepharoplasty (eyelid surgery), breast augmentation or reduction, abdominoplasty (tummy tuck), liposuction, and otoplasty (ear correction). Patients seeking cosmetic surgery should be in good physical and psychological health, have realistic expectations, and have the decision reviewed by the surgeon to exclude body dysmorphic disorder, which is an absolute contraindication to elective cosmetic procedures.

Pre-operative planning for plastic surgery is multidisciplinary and highly individualised, varying considerably between reconstructive and cosmetic procedures.

Pre-operative planning: For reconstructive cases, photographs document the deformity and planned correction. 3D surface imaging and computer-aided surgical simulation are used for complex facial and breast reconstruction. Oncological coordination ensures surgical margins are clear before reconstruction proceeds. For cosmetic procedures, standardised photographic documentation, written communication of patient goals, and 3D Vectra imaging for breast and rhinoplasty cases allow simulation of likely outcomes and informed consent.

Anaesthesia: Minor cosmetic procedures — blepharoplasty, minor rhinoplasty, otoplasty, small excisions — are performed under local anaesthesia with sedation in a day-case setting. Major cosmetic surgery (facelift, abdominoplasty, breast augmentation, body contouring) and all reconstructive procedures require general anaesthesia in a hospital operating theatre.

Closure techniques: Direct closure (tension-free layered closure with absorbable deep sutures and non-absorbable or absorbable skin sutures) is suitable for small defects with adequate tissue mobility. Skin grafting — split-thickness (0.3-0.5 mm) or full-thickness — covers defects where primary closure would distort local tissue. Local flaps mobilise adjacent tissue on a vascular pedicle to fill defects while preserving the blood supply. Regional pedicled flaps (latissimus dorsi, TRAM, rectus abdominis) rotate or advance distant vascularised tissue.

Microsurgical free flap transfer: The most advanced technique, free tissue transfer (free flap surgery) detaches a block of skin, fat, muscle, or bone from a donor site (e.g., deep inferior epigastric perforator [DIEP] flap from the abdomen; anterolateral thigh [ALT] flap from the thigh) with its feeding artery and draining vein. The flap is inset at the recipient site and the artery and vein are anastomosed to recipient vessels under an operating microscope at 5-10x magnification. The anastomosed vessels must be re-established before warm ischaemia time exceeds 4-6 hours. Post-operative flap monitoring every 1-2 hours in the first 48 hours detects early vascular compromise requiring urgent re-exploration.

Scar management: Incision placement in natural skin creases, relaxed skin tension lines, and anatomical boundaries (hairlines, subcutaneous ridges) minimises visible scarring. Meticulous layered wound closure without skin tension and use of fine calibre sutures optimises scar quality.

Outcomes depend on procedure type and surgeon experience. Breast reconstruction after mastectomy achieves high patient satisfaction in over 80% of cases, significantly improving body image, psychosocial wellbeing, and quality of life compared with no reconstruction. Cleft lip and palate repair achieves excellent functional and aesthetic outcomes in over 90% of cases when performed by experienced paediatric plastic surgeons in the first year of life. Cosmetic rhinoplasty revision rates are 10–15%, highlighting the importance of careful pre-operative planning and communication. Free flap success rates exceed 95% at high-volume microsurgery centres with experienced teams and appropriate post-operative monitoring. Seeking board-certified surgeons at accredited facilities significantly reduces complication risk and improves long-term outcomes for both reconstructive and cosmetic procedures. Reconstructive plastic surgery following cancer resection (mastectomy, head and neck ablation, sarcoma resection) restores body image, self-esteem, and quality of life, with outcomes equivalent to non-cancer patients in long-term follow-up. Aesthetic plastic surgery achieves high patient satisfaction rates (85–90%) when appropriate patient selection, realistic expectations, and experienced surgeons are involved. Cleft lip and palate repair at appropriate developmental stages achieves excellent functional speech and aesthetic outcomes. Burns scar management through early grafting and contracture release prevents permanent functional disability.

Common risks across plastic surgery include haematoma (blood collection requiring drainage, 1–5%), seroma (fluid accumulation, 5–15% in breast surgery), wound dehiscence, surgical site infection (2–5%), hypertrophic or keloid scarring, anaesthesia reactions, nerve injury causing temporary or permanent numbness, and unsatisfactory aesthetic result requiring revision. For free flap reconstruction, flap failure from vessel thrombosis occurs in 2–5% and requires urgent operative re-exploration; early warning signs (colour change, Doppler signal loss) are monitored hourly post-operatively. Breast implant-specific risks include capsular contracture (10–20% at 10 years), implant rupture, and the rare breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) with textured surface implants. Cosmetic surgery performed in non-accredited facilities or by non-qualified practitioners carries substantially higher complication rates. General plastic surgery risks include surgical site infection, haematoma, seroma (fluid collection), wound dehiscence, hypertrophic scarring and keloid formation, asymmetry, and anaesthesia complications. Implant-based procedures (breast augmentation, tissue expanders) carry additional risks of capsular contracture (hardening around the implant — Baker Grade III-IV requiring revision in 5–10%), implant rupture or displacement, and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) for textured implants. Body contouring after massive weight loss carries higher complication rates due to skin quality, nutritional status, and prior bariatric surgery effects on healing.

Recovery varies significantly by procedure type and complexity. Minor cosmetic procedures (blepharoplasty, minor rhinoplasty) allow return to social activities in 2–3 weeks, though bruising and swelling persist for 4–6 weeks. Major cosmetic surgery (facelift, abdominoplasty) requires 3–4 weeks of social recovery and 6–8 weeks before strenuous activity. Major reconstructive microsurgery — free flap reconstruction, extensive head and neck reconstruction — may require 4–6 weeks of inpatient or supported recovery, with functional rehabilitation continuing for months. Compression garments are worn for 6 weeks after liposuction or body contouring to reduce swelling and optimise results. Scar management with silicone gel sheets or ointment is applied from 3–4 weeks after wound healing, continued for 6–12 months. Sun protection of scars for 12 months is essential. Final aesthetic results may take 6–12 months to be fully apparent as swelling resolves and scars mature.