Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Auricular reconstruction is performed under general anesthesia. This ensures the patient is completely unconscious, feels no pain, and remains perfectly still for the delicate sculpting and suturing required. The airway is secured with an endotracheal tube.
Pediatric anesthesiologists are typically involved for child patients to manage their specific physiological needs. Long-acting local anesthetics are injected into the surgical sites (chest and ear) toward the end of the procedure to provide pain relief that lasts for several hours into the recovery period.
The surgery takes place in a sterile operating room. The patient is positioned to allow simultaneous access to the chest (for rib harvest) and the head. The head is turned to expose the microtia site, while the chest is draped to expose the costal margin.
The room is kept warm to maintain the patient’s body temperature. The surgeon uses specialized lighting and often surgical loupes (magnifying glasses) to visualize the fine details of cartilage carving and skin suturing.
If performing autologous reconstruction, the chest incision is made first. The surgeon carefully dissects down to the rib cage, sparing the abdominal muscles as much as possible. The perichondrium (the lining of the rib) is often preserved to help regenerate cartilage or seal the chest wall.
Segments of the 6th, 7th, 8th, and sometimes 9th ribs are removed. The surgeon checks the chest wall for air leaks (pneumothorax) by filling the wound with saline and inflating the lungs. The chest incision is then closed in layers, often with a small pain pump catheter left in place.
While an assistant closes the chest, the lead surgeon begins carving the cartilage at a separate back table. Using the template from the normal ear, the main cartilage block is etched to form the base plate (scapha and antihelix).
Thinner slices of cartilage are carved to form the helix rim and the tragus. These pieces are assembled using fine stainless steel wire or permanent sutures. The result is an exquisite 3D framework that replicates the curves and shadows of a natural ear.
The surgeon then turns to the ear site. The vestigial cartilage (the peanut) is removed or reshaped to form the lobule. A skinny skin pocket is dissected in the mastoid area. The skin must be elevated carefully to preserve its blood supply; if it is too thin, the cartilage will be exposed; if too thick, the definition is lost.
The framework is inserted into this pocket. The skin is draped over it. This is the critical moment where the ear takes shape. The surgeon ensures that no tension on the skin edges could cause necrosis.
To make the skin adhere to the framework’s contours, suction is applied. One or two small silicone drains are placed under the skin flap and connected to a vacuum test tube (Vacutainer).
This vacuum effect pulls the skin down into the grooves of the helix and antihelix, instantly revealing the ear’s shape. It also prevents blood from collecting (hematoma) between the skin and the cartilage. These drains remain in place for several days.
The patient is moved to the recovery room (PACU). Nurses monitor vital signs and manage immediate pain or nausea. The chest dressing is checked for bleeding, and the ear dressing is checked to ensure the vacuum seal is maintaining the ear’s shape.
A bulky “glasscock” dressing or a protective cup is placed over the ear to prevent any pressure on the new framework. The patient is usually kept in the hospital for observation to manage pain and monitor the drains.
The chest donor site is the primary source of pain. Surgeons use a multimodal approach. This includes the intraoperative injection of Exparel (a 3-day numbing medication), IV narcotics, and muscle relaxants to prevent spasms in the chest wall.
Patient-Controlled Analgesia (PCA) pumps may be used on the first night. Transitioning to oral pain medication happens over the next few days. The ear site itself is surprisingly painless compared to the chest.
Patients undergoing rib cartilage reconstruction typically stay in the hospital for 2 to 3 days. This allows for aggressive pain control and monitoring of the chest for any respiratory issues (such as atelectasis or a pneumothorax).
Patients undergoing Medpor reconstruction often have a shorter stay (1 to 2 days) or may even be treated as outpatients, as there is no chest incision to manage.
The drains are the most critical part of the early recovery. They must maintain suction to keep the skin adhered to the framework. If suction is lost, the ear canal can become blocked, or fluid can build up.
Drains are typically removed between days 3 and 5, once the skin has adhered sufficiently and fluid output is minimal. This is usually done in the clinic. The removal is quick and generally not painful.
Once the big dressings are removed, the ear may look bruised and swollen. Antibiotic ointment is applied to the suture lines. The patient (or parents) must keep the area clean and dry.
Hair washing is usually restricted for the first week to keep the incisions dry. Afterwards, gentle washing with baby shampoo is allowed, avoiding direct scrubbing of the ear or chest wound.
Activity is strictly limited. No heavy lifting, running, or rough play is allowed for 4 to 6 weeks. The chest wall needs time to heal, and the ear must be protected from any trauma.
Sleeping position must be modified; the patient cannot sleep on the new ear side. A donut pillow or travel pillow can help keep pressure off the ear if the patient rolls over.
Send us all your questions or requests, and our expert team will assist you.
The first stage of rib cartilage reconstruction (carving and placement) typically takes 4 to 6 hours. Subsequent stages are shorter, usually 1 to 2 hours. Medpor reconstruction can take 6 to 8 hours as it often combines steps.
Usually, no. A chest tube (to re-inflate the lung) is only needed if the lung lining was accidentally nicked during surgery. Surgeons check for this before closing. A small pain catheter might be left in, but that is different from a chest tube.
Pain is expected, especially from the ribs, but the anesthesia team works hard to minimize it. Numbing blocks placed during surgery mean the child often wakes up comfortable, with the pain increasing gradually as the blocks wear off, at which point IV meds are used.
No. Because it is the patient’s own tissue (autologous), the body recognizes it as “self” and will not reject it. This is the main advantage over synthetic implants, which the body can sometimes try to push out.
If a drain loses suction or falls out early, you must call the surgeon immediately. The skin can lift off the framework, filling with blood or fluid, which can distort the ear’s shape. It may need to be replaced or aspirated in the office.
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