Plastic surgery: reconstructive and aesthetic procedures, who treats you and how referral works

Plastic surgery takes its name from the Greek word for shaping, not from the material. The specialty is concerned with the repair and reconstruction of skin, soft tissue, bone and sometimes nerves and vessels, and it sits across several areas of medicine: trauma, cancer care, congenital conditions, burns, hand surgery and aesthetic surgery. The British Association of Plastic, Reconstructive and Aesthetic Surgeons describes itself as the voice of plastic surgery in the UK and runs a public information hub for patients.

A consultant plastic surgeon is a doctor who has completed medical school, general surgical training and then a long, structured period of specialist training in plastic surgery. Many take further fellowship training in one area, so the surgeon who reconstructs a breast after cancer may not be the one who repairs a hand injury or treats a burn. In reconstructive work the surgeon usually operates within a team that includes cancer surgeons, dermatologists, anaesthetists, specialist nurses, hand therapists, physiotherapists and psychologists.

It is worth separating reconstructive work, which is widely provided on the NHS, from purely aesthetic surgery, which is mostly private. The same title, plastic surgeon, appears in both, so it helps to ask specifically about a surgeon's training and what share of their practice involves the procedure you are considering.

The range is wide, and the main groups are listed here. Not every unit offers every service, and complex work is often concentrated in regional centres.

• Burns and scalds. Small burns can often be treated at home, while the NHS says severe burns that are large or deep may need treatment in hospital, which can include surgery to repair the wound or reconstruct damaged skin. Specialist burns services also deal with scarring and contracture afterwards.

• Skin cancer and other skin lesions. Surgeons remove skin cancers and then close or reconstruct the area, particularly on the face, where appearance and function are both important. Some work with dermatologists on specialist excision techniques.

• Breast reconstruction after mastectomy, using an implant, the patient's own tissue or a combination, plus procedures for symmetry and nipple reconstruction.

• Congenital differences such as cleft lip and palate, ear differences and hand differences, managed over childhood in specialist teams.

• Injury and wound problems, including facial and limb trauma, tendon injuries, chronic wounds and complex limb reconstruction using flaps and microsurgery.

• Hand conditions such as carpal tunnel syndrome and Dupuytren's contracture, which in many hospitals are handled by plastic or orthopaedic hand surgeons.

• Scars, keloids and lymphoedema, plus body contouring after major weight loss.

• Aesthetic procedures such as eyelid surgery, rhinoplasty, breast augmentation or reduction, liposuction and facial surgery, which are usually elective and often privately funded.

Assessment is largely clinical. The surgeon examines the area, discusses what you hope to change or restore and, depending on the problem, may request photographs, imaging, a skin biopsy or measurements of function such as grip or movement. For cancer-related reconstruction, the surgical plan is normally agreed at a multidisciplinary meeting alongside oncology colleagues.

Reconstruction is often described as a ladder. The simplest option is direct closure with stitches. Next come skin grafts, where a thin layer of skin is taken from another area to cover a wound, and local flaps, where nearby tissue is moved while keeping its blood supply. At the most complex end are free flaps, in which a block of tissue is detached and reconnected to blood vessels under an operating microscope, a technique called microsurgery. Surgeons choose the simplest option that gives a good result, which is not always the most advanced one.

Planning matters as much as the operation. Recovery depends on the technique, and some procedures need time off work, dressings, supportive garments and staged surgery over months or years. Smoking, diabetes and obesity can affect wound healing, and surgeons commonly ask people to stop nicotine in any form before elective surgery.

On the NHS, reconstructive plastic surgery normally starts with a referral from a GP, a hospital doctor, a dermatologist or a cancer team. Cancer reconstruction is often discussed before the first operation, and in the case of breast reconstruction the NHS says it may be done at the same time as a mastectomy. Burns and major trauma are managed through regional specialist networks, and cleft care happens in specialist cleft centres with a long-term plan that follows a child through growing up.

NHS funding for purely cosmetic procedures is generally very limited, although a procedure to correct a functional problem or significant distress may sometimes be considered, and local policies vary between areas, so it is worth asking the referring clinician what applies. Privately, a person can usually see a plastic surgeon after a GP letter or by self-referral. Costs vary widely, so it is sensible to check what the quoted fee includes: the consultation, the surgeon's fee, hospital and anaesthetic charges, implants or devices, follow-up appointments and any treatment if a complication occurs.

• Ask about the surgeon's training, how often they perform the procedure and what results and complication rates they see.

• Ask what the realistic outcome is, what scarring to expect, how long recovery will take and whether further operations are likely.

• Ask who will look after you if there is a complication, where, and whether that care is included in the price.

• NHS guidance on cosmetic procedures suggests asking about the products used, what could go wrong and whether you will be given a cooling-off period, and being cautious about clinics found through social media.

• Bring photographs of how things looked before, a list of medicines and details of any previous surgery or anaesthetic problems.

• Call 999 or go to A&E for a burn that is very large or deep, is on the face, genitals or bottom, or was caused by a chemical or electricity, as the NHS advises. Get urgent advice from NHS 111 for a wound that is bleeding, a post-operative wound that is becoming red, hot and increasingly painful, or fever after surgery.