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Microsurgery · UK

Reconstructive microsurgery - under the microscope.

Free flaps for breast, head and neck and limb salvage. Digital replantation for amputations. Super-microsurgery for lymphoedema. Six-to-twelve-hour operations by fellowship-trained consultants in units with proper ICU flap monitoring.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private microsurgery costs in the UK.

Indicative ranges across our microsurgery partner units.

In short

£18,000–£28,000, home after 5–7 nights.

Procedure Indicative range
DIEP flap breast reconstruction (unilateral) £18,000–£28,000
DIEP flap breast reconstruction (bilateral) £28,000–£45,000
ALT (anterolateral thigh) free flap £15,000–£25,000
Free fibula flap (mandible reconstruction) £22,000–£38,000
Gracilis free functional muscle transfer £18,000–£30,000
Digital replantation (single digit) £12,000–£20,000
Lymphaticovenous anastomosis (LVA) £8,000–£15,000
Vascularised lymph node transfer (VLNT) £15,000–£25,000
Microsurgery consultation only £300–£500

Prices vary by hospital, surgeon and complexity. Long operations, bilateral flaps, ICU stays and cases involving bone all sit at the top of the range.

The problem

Microsurgery is a volume game - and infrastructure decides outcomes.

Flap success is not just about the anastomosis. It is about the theatre lists, the ICU monitoring, the 24/7 return-to-theatre pathway and the annual volume of the surgeon. All four have to be right.

  • Volume matters, more than for almost any other operation

    A microsurgeon doing fewer than 30–40 free flaps per year has measurably worse outcomes. We only route to high-volume operators.

  • ICU monitoring is not optional

    Trained hourly flap observations in the first 72 hours save flaps. A ward without that training is not the right place for a free flap patient.

  • Salvage in hours, not days

    A compromised flap salvaged inside 4–6 hours usually survives. Beyond 12 hours it usually does not. That means a 24/7 microsurgery on-call.

When it helps

When microsurgery is the right step.

The situations we see most, plus the one red flag that means a same-day hand trauma team rather than a routine appointment.

  • Post-mastectomy breast reconstruction

    Autologous reconstruction using DIEP, SIEA, TUG or PAP flaps - your own tissue, not implants, with natural feel and long-term durability.

  • Head and neck oncologic reconstruction

    After tumour resection: fibula for mandible, ALT for oral cavity and pharynx, radial forearm for tongue - restoring form, speech and swallowing in one operation.

  • Lower limb salvage after trauma

    Open tibial fractures, degloving injuries or chronic osteomyelitis where local tissue is inadequate - a free flap can save a limb otherwise destined for amputation.

  • Digital or limb replantation

    Amputated fingers, thumbs, hands or partial limbs replanted within 6–12 hours of injury - cold ischaemia gives a longer window, warm ischaemia a much shorter one.

  • Chronic lymphoedema (breast, gynae, primary)

    Super-microsurgery - LVA and VLNT - for early to moderate lymphoedema of the arm or leg. Not a cure, but often meaningful reduction in volume and infections.

  • Nerve reconstruction with vascularised graft

    Long-gap peripheral nerve injuries where a vascularised nerve graft (e.g. sural on its own blood supply) outperforms a non-vascularised graft.

  • Perineal and pelvic reconstruction

    After abdominoperineal resection or extended pelvic surgery - VRAM, gracilis or ALT flaps to fill dead space and heal irradiated tissue.

  • Red flag: fresh amputation of a digit or limb

    A fresh amputation is a same-day surgical emergency. Wrap the part in saline-moistened gauze, seal in a bag on ice (not directly on ice), and go straight to A&E - call the hand trauma team en route.

Procedure options

What each flap involves, its typical use and its donor-site trade-off. The right flap is the one that reconstructs your defect with the smallest cost elsewhere.

  • DIEP flap

    Deep inferior epigastric artery perforator flap. Lower abdominal skin and fat on one or two perforators. The gold standard for autologous breast reconstruction - the muscle stays behind.

  • ALT flap

    Anterolateral thigh flap. A workhorse fasciocutaneous free flap for head and neck, limb and trunk reconstruction. Large surface area, long pedicle, low donor-site morbidity.

  • Free fibula flap

    Vascularised bone from the fibula, up to 25 cm, with skin paddle. The standard for mandibular reconstruction and long-bone defects. Walking is preserved.

  • Gracilis free flap

    Small, expendable inner-thigh muscle. Used as free functional muscle transfer for facial reanimation, brachial plexus reconstruction, and perineal reconstruction.

  • Radial forearm flap

    Thin, pliable fasciocutaneous flap on the radial artery. Excellent for oral cavity, pharynx and thumb reconstruction. Donor-site scar is the trade-off.

  • Digital replantation

    Reattachment of amputated fingers or thumbs - bone fixation, tendon repair, artery and vein anastomosis under microscope, then nerve coaptation. Success depends on level, mechanism and ischaemia time.

  • Super-microsurgery (LVA)

    Lymphaticovenous anastomosis for lymphoedema - connecting lymphatic vessels (0.3–0.8 mm) to venules under 40× magnification, with 11-0 or 12-0 sutures. Multiple sites per limb.

  • Vascularised lymph node transfer

    Lymph nodes from groin, submental, supraclavicular or omental sites transferred to a lymphoedematous limb - offers the potential for long-term nodal drainage.

Safety and recovery

What to expect afterwards - honestly.

Microsurgery is a big operation with a long recovery. Success rates are high in the right hands, but flap monitoring, smoking cessation and rehabilitation are non-negotiable parts of the deal.

  • Flap failure - the honest number

    Free flap failure in experienced UK units runs at 1–5% overall, with partial flap loss slightly higher. Salvage back to theatre within 4–6 hours of a problem saves most compromised flaps.

  • The first 72 hours matter most

    Most flap problems (arterial thrombosis, venous congestion) happen within 72 hours. That is why hourly ICU monitoring, hand-held Doppler and clinical assessment are non-negotiable - not a nice-to-have.

  • Donor-site morbidity is real

    DIEP leaves an abdominal scar and small hernia risk. Fibula flap can cause ankle stiffness. ALT leaves a thigh scar. Gracilis is well-tolerated. We discuss donor site as carefully as the reconstruction itself.

  • Smoking causes flap failure

    Nicotine constricts small vessels. Every microsurgeon requires a minimum 4–6 weeks smoke-free before surgery, with cotinine testing where needed. Vaping is not a workaround.

  • Long anaesthetic, DVT and pressure

    6–12 hour operations carry a real risk of DVT, PE and pressure sores. Warming, compression, positioning and post-op anticoagulation are standard. Fitness for a long GA is assessed carefully.

  • Bleeding, infection, wound problems

    Bleeding and infection in the low single digits. Delayed wound healing is more likely at the donor site than the flap. Diabetes and steroid use raise risk.

  • Replantation success is level-dependent

    Thumb replants have the highest priority and best outcome. Distal fingertip replants beyond the DIP joint are technically hardest. Ring avulsion and crush injuries have lower survival than sharp guillotine amputations.

  • Sensation and function take a year

    Sensation returns slowly - 12–24 months for a free flap, with variable recovery. Functional muscle transfers take 6–12 months to demonstrate meaningful movement. Structured hand or physiotherapy is essential.

  • Red flags after surgery

    A flap that turns dusky, pale, cold or swollen, sudden severe pain, bleeding, fever or breathlessness needs the same-day team or A&E - flap salvage is time-critical.

Reading your operation note

Your microsurgery note in four parts. Read the last one first.

Whichever flap was used - DIEP, ALT, fibula, gracilis - the note the microsurgeon sends you keeps to the same shape.

A UK consultant microsurgeon reviewing a patient’s operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to walk you through the operation note and the flap-monitoring plan before your ward round, just ask.

  1. 01 Header

    Defect, flap and pedicle

    What was being reconstructed, which flap was used (DIEP, ALT, fibula, gracilis, radial forearm), which pedicle vessels, and which recipient vessels the anastomosis was made to.

  2. 02 Technique

    Anastomosis, ischaemia time and monitoring

    Number and type of arterial and venous anastomoses (end-to-end, end-to-side), suture size, warm and cold ischaemia times, and the monitoring plan agreed for ICU.

  3. 03 Findings

    Flap perfusion and donor site

    How the flap looked at end of case (colour, capillary refill, Doppler signal), any intraoperative revisions of anastomosis, and how the donor site was closed.

  4. 04 Impression

    Aftercare, rehab and long-term plan

    Read this first: the monitoring schedule, flap positioning restrictions, physiotherapy plan, lymphoedema garment plan where relevant, and follow-up milestones.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Post-cancer reconstruction and trauma-related microsurgery are usually covered.

Frequently asked

Everything we get asked about microsurgery.

Quick answers on flap survival, replantation, lymphoedema, cost and recovery.

  • What is reconstructive microsurgery?

    Surgery performed under an operating microscope at 10×–40× magnification to reconnect blood vessels, nerves and lymphatics under 3 mm across. It underpins free tissue transfer (free flaps), digital replantation, nerve reconstruction and lymphoedema surgery. Super-microsurgery goes further, working on vessels under 0.8 mm with 11-0 and 12-0 sutures.

  • How long does a free flap operation take?

    Typically 6–12 hours, sometimes longer for bilateral DIEP or fibula head-and-neck reconstruction. The length reflects careful flap harvest, meticulous microvascular anastomosis and reliable inset - rushing any step raises the risk of flap failure. You are asleep throughout under general anaesthetic.

  • How likely is a free flap to fail?

    In experienced UK units, overall free flap survival runs at 95–99%. Partial flap loss and wound complications are more common than total loss. Most failures happen within the first 72 hours, which is why hourly monitoring in ICU or HDU and a 24/7 return-to-theatre pathway are essential - early salvage saves most compromised flaps.

  • Can an amputated finger be reattached?

    Sometimes. Best outcomes are for sharp, guillotine-type amputations in healthy adults, thumbs above the interphalangeal joint, and multiple-digit amputations. Cold ischaemia time up to about 12 hours is workable; warm ischaemia beyond 6 hours is not. Wrap the part in saline-moist gauze, seal in a bag on ice, and get to a hand trauma centre immediately.

  • What does private reconstructive microsurgery cost in the UK?

    Roughly £15,000–£45,000 for a free flap operation, £12,000–£20,000 for a digital replant, £8,000–£15,000 for lymphaticovenous anastomosis, and £15,000–£25,000 for vascularised lymph node transfer. The range reflects flap choice, complexity, ICU stay and length of hospitalisation.

  • Does the NHS do microsurgery - why go private?

    The NHS provides world-class microsurgery in a small number of tertiary units - for many patients that is the best route. Private routes are chosen for shorter waits for elective breast reconstruction, choice of specific surgeon or flap, or for lymphoedema surgery where NHS provision is limited. Emergency replantation and trauma reconstruction almost always go via NHS trauma centres because of infrastructure.

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