Es el tratamiento quirúrgico más utilizado en la actualidad en todo el mundo. Se inició hace muchos años y se ha ido perfeccionando hasta conseguir resultados cercanos a la normalidad. El uso de tejidos propios del paciente evita el rechazo y no precisa de cuidados especiales.

El proceso se lleva a cabo mediante 2 cirugías principales y se inicia a los 10 años. A esta edad la oreja alcanza el 90% del tamaño de una oreja adulta. También se necesita una talla superior a 140 cm para que los cartílagos costales tengan tamaño suficiente para una reconstrucción completa. Se utiliza como modelo la oreja contralateral.

En la primera cirugía se extraen 4 cartílagos costales, que luego regeneran y se construye el esqueleto de la oreja reproduciendo todos sus relieves y depresiones. Esta estructura se ubica en un bolsillo subcutáneo en el sitio exacto donde debería ir la oreja y el pequeño lóbulo, que suele estar presente incluso en pacientes con grado 3 de microtia, se coloca en la posición normal. Entonces, se aplica succión al injerto para conseguir que la piel se adapte perfectamente al contorno de la oreja reconstruida, y por último se sutura la incisión en la piel.

Un año después de la primera cirugía, se separa la oreja de la cabeza y se realiza un injerto de piel para formar el surco retroauricular. Existen diversas técnicas y zonas para obtener el injerto de piel.

Más adelante, pueden ser necesarias cirugías menores para ajustar imperfecciones o añadir otras características que hagan la estructura más realista. Si se opta por  una cirugía para reparar la atresia, ésta deberá llevarse a cabo después de que haya finalizado el proceso de reconstrucción con cartílago costal.

La gran ventaja de este procedimiento es que la oreja esta reconstruida con sus propios tejidos y que variará muy poco a lo largo de su vida de adulto.

Testimonios de pacientes que se han sometido a esta cirugía declaran que no han tenido problemas de lesiones graves con orejas reconstruida. Ni el impacto directo de una pelota de fútbol parece dañar la oreja reconstruida de esta forma, como sería el caso de una oreja natural. Por lo tanto no son necesarias medidas de protección o seguridad especial.

Algunos de los más renombrados cirujanos del mundo costilla reconstrucción del injerto incluyen:

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