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Reconstruction Options

Rib Graft Reconstruction

Using an autologous rib graft transplant is the most widely accepted approach to microtia reconstruction. A piece of rib cartilage is removed from the person with microtia, formed into the shape of the ear cartilage that is missing, and then inserted under the skin around the ear. This cartilage serves as a framework for the new ear.

The advantages of this technique include:

no foreign materials, thus no risk of rejection
your own skin covers the new ear, no grafts or donor skin, again, no risk of rejection

Disadvantages of this technique include:

several surgeries (2-4) required for unilateral repair, bilateral microtia reconstruction using the rib graft technique generally requires a minimum of 5 procedures.
incision in the chest to remove cartilage
generally wait until age 6-7 before surgery can begin

Rib graft microtia reconstruction is a highly skilled subspecialty of plastic surgery. Do not believe any random plastic surgeon (even if board certified) who says they can perform this surgery. Ask for before and after pictures, patient references, and failure rates. There are only a handful of doctors (click here to go to list) in the world who perform rib graft microtia reconstruction as their only plastic surgeon specialty. It is always best to try and see one of these doctors, as they have the most experience, they generally have the best outcomes and the fewest failures.

Medpor

Medpor is a more recent addition to the microtia reconstruction surgical arsenal. Medpor is porous polyethelene, basically, a piece of surgical plastic which replaces using the rib in the ear reconstruction process. Microtia reconstruction using Medpor can start much earlier than rib grafts (as early as age 3).

Using Medpor requires special training, and as of this writing, only two doctors (click here to go to list) in the United States are performing microtia reconstruction using Medpor as their primary plastic surgery specialties.

The advantages of this technique include:

2 surgical procedures instead of 4
No rib harvest
Better ear projection
Less concern about scar tissue present prior to surgery
since flap from scalp is used over the implant
Canalplasty/BAHA can be done prior to Medpor reconstruction
Reconstruction can be done at age 3-4 instead of 6-10

Prosthetic Ears

A new prosthetic ear can be molded, and held in place by titanium inserts. Some surgery is required to install the titanium abutments, but this can be combined with BAHA surgery. Advantages of the prosthetic ear over the reconstruction is that it is relatively minor surgery. Disadvantages - prosthetics may fall off; need multiple prosthetics for different seasons (because of skin tanning); and the need to replace prosthetics (in the case of unilateral microtia) as the child’s normal ear grows.

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