Sydney

Reconstructive Surgery

Reconstructive surgery treats a medical problem: tissue lost to cancer, damage from an accident, or a difference present from birth. Cosmetic surgery changes the appearance of otherwise normal, healthy tissue by choice. The distinction matters because it affects Medicare eligibility, private health cover and which regulatory guidelines apply to your care.

Both are performed by specialist plastic surgeons, and the technical skills overlap a great deal. The same operation can also sit on either side of the line depending on the patient. A breast reduction may be cosmetic for one woman and reconstructive for another with significant neck, back and shoulder symptoms. Because the boundary is not always obvious from the outside, A/Prof Bish Soliman will assess your situation against the relevant clinical criteria and tell you plainly which category your procedure falls into, and what that means for your costs and consent.

Often, yes. Where a reconstructive procedure is medically necessary and meets the criteria of a Medicare Benefits Schedule (MBS) item number, a Medicare rebate applies. This includes breast reconstruction after mastectomy, excision and repair of skin cancers, and reconstruction after trauma. A rebate, however, does not always mean there is nothing left to pay.

Post-mastectomy breast reconstruction is covered by a range of MBS items (45530 to 45558), spanning autologous flap reconstruction, implant-based reconstruction, tissue expansion and nipple reconstruction. Purely cosmetic procedures attract no rebate at all. Which item numbers apply to you depends on the operation planned, so these are identified and confirmed in writing before surgery, along with what Medicare and your health fund are expected to contribute.

Yes. You need a referral from your GP or another specialist to consult A/Prof Bish Soliman, and a current referral is also required for you to claim a Medicare rebate on the consultation. A referral from a GP is valid for 12 months. A referral from one specialist to another is valid for three months.

If you have been diagnosed with cancer, the referral usually comes from your GP, breast surgeon, dermatologist or oncologist. Ask for the reason for referral and your relevant history to be included, and bring any imaging and pathology results with you to the appointment. Without a current referral your consultation can still go ahead, but it will not be rebatable, so it is worth sorting out beforehand.

No. The Medical Board of Australia’s guidelines for practitioners who perform cosmetic surgery state that they do not apply to reconstructive surgery. The mandatory seven-day cooling-off period, the cosmetic surgery referral requirements and the associated psychological screening provisions therefore do not apply to reconstructive procedures.

Reconstructive surgery is governed instead by the general standards that apply across medical practice, together with the usual requirements for informed consent. That does not mean anything is rushed. You will have time to weigh up your options, ask questions and return for a second appointment if you want one before committing. Where cancer treatment is involved, the timing of surgery is generally driven by your oncology plan rather than by any fixed waiting period.

Costs vary considerably depending on the procedure, the hospital, the length of the operation and your level of private health cover. Your out-of-pocket cost is the difference between what you are charged and what Medicare and your health fund pay between them. You will receive a written breakdown before you commit to surgery.

For an MBS-listed procedure performed in hospital, Medicare pays 75 per cent of the schedule fee, and where your policy covers that procedure your insurer generally pays at least the remaining 25 per cent. Any amount charged above the schedule fee is yours to cover. There are also separate accounts from the anaesthetist, the assistant surgeon and the hospital itself. Setting all of this out in writing is known as informed financial consent and is a standard obligation. Before booking, check your hospital cover tier and any waiting periods directly with your fund.

That depends heavily on the procedure. A small skin cancer excision with local repair may be largely healed within two to three weeks. Larger flap reconstructions more commonly need four to eight weeks before you return to routine activity, and several months before swelling settles and the final shape becomes clear.

Free flap operations involve a second surgical site where the tissue was taken from, so your recovery covers both areas. Expect restrictions on lifting, driving and exercise, and arrange help at home for the first week or two. Scars keep changing for 12 to 18 months after surgery. A/Prof Bish Soliman will give you a recovery timeline specific to your operation at your pre-operative appointment, and your follow-up visits are scheduled around it.

Yes. Breast reconstruction can be immediate, performed during the same operation as the mastectomy, or delayed by months or even years afterwards. Cancer Australia confirms there is no time limit on delayed reconstruction, so women who declined it at the time of diagnosis are still able to revisit the option later.

Immediate reconstruction means one anaesthetic and often better preservation of the breast skin. Delayed reconstruction gives you time to finish chemotherapy or radiotherapy and to make the decision without pressure. Radiotherapy in particular can affect which techniques are suitable, which is one reason some patients are advised to wait. Reconstruction after mastectomy attracts a Medicare rebate. You can read more about the technique on the DIEP flap breast reconstruction page.

Microsurgery is surgery performed under an operating microscope to join blood vessels only a few millimetres across. It allows a free flap, a piece of living tissue with its own blood supply, to be moved from one part of your body to another. Published success rates for free flap transfer sit at around 96 per cent.

A systematic review and meta-analysis published in Microsurgery in 2023 (Escandon and colleagues) reported an overall flap success rate of 96.6 per cent, with a 95 per cent confidence interval of 95.2 to 98.1 per cent. Those are pooled figures from the published literature rather than a prediction for any individual patient. Your own level of risk depends on factors including smoking, diabetes, previous radiotherapy and the site being reconstructed. Flaps are monitored closely for the first 48 to 72 hours, when problems with the vessels are most likely to appear. A/Prof Bish Soliman holds two consultant microsurgery positions at major Sydney tertiary referral hospitals.

It depends on the size and site of the wound. Small defects are usually closed directly with sutures. Larger ones, and those on the face where the skin is under tension, may need a skin graft or a local flap to close the gap while preserving how the area looks and functions.

A graft takes thin skin from elsewhere, commonly in front of or behind the ear, the neck or the upper arm, and lays it over the wound. A flap moves nearby skin along with its own blood supply into the defect, which usually gives a closer match in colour and texture. Cancer Council Australia estimates that at least two in three Australians will be diagnosed with skin cancer in their lifetime, so this is common work. Where possible the repair is planned before the excision so both are completed in the one procedure. If pathology later shows the margins are not clear, further surgery may be needed.

Facial reconstruction rebuilds the structures of the face after cancer removal, trauma or a congenital difference, and can involve skin, cartilage, bone and the muscles that control movement. Any surgical incision leaves a scar. The work lies in planning and placing incisions so that the resulting scar is as inconspicuous as the anatomy allows.

Scars are positioned along natural skin creases and the borders between facial features wherever possible, and the repair is planned by facial unit so that a reconstructed nose, lip or eyelid holds its shape and still functions properly. Nasal reconstruction after skin cancer sometimes needs more than one stage. Healing also takes time: most facial scars flatten and fade noticeably over 12 to 18 months, and treatments such as silicone, taping and in some cases laser or steroid injection can support that process. A/Prof Bish Soliman will talk you through where your scars will sit before you agree to surgery.

Reconstructive surgery draws on specific training in tissue transfer, microsurgery and wound repair. In Australia, only practitioners holding specialist registration in surgery, obstetrics and gynaecology or ophthalmology may use the title ‘surgeon’, a restriction that commenced on 20 September 2023, which makes checking credentials reasonably straightforward.

A Specialist Plastic and Reconstructive Surgeon holds FRACS (Plastic Surgery), awarded after completing accredited training with the Royal Australasian College of Surgeons. You can verify any practitioner’s registration and specialty yourself on the AHPRA register. A/Prof Bish Soliman is AHPRA registered (MED 0001679053) with specialist registration in plastic surgery, holds FRACS (Plastic Surgery), MS (Plastic Surgery) and MBBS (Hons 1), and holds two consultant microsurgery positions at major Sydney tertiary referral hospitals.