PIP Implant Replacement Surgery & Removal of Silicone Granulomas by Mr Prashant Govilkar17th February 2012
Implant Removal / Replacement
Replacement of intact PIP implants which caused formation of silicone granuloma by silicone gel bleed inside the breast capsule. PIP implants are known for having a superficial coat layer which allows silicone to get through the coating of the implant and form silicone granulomas. In this video, Aurora's plastic and reconstructive surgeon Prashant Govilkar, shows how these granulomas are placed inside the breast capsule although the PIP implants were intact, and how they are best removed. For more information on PIPs or should you wish to book a free consultation with any of our highly qualified breast surgeons, please call our free office number 0800 3285743.
What I’m doing here is using sterile dressings which we term as nipple sheets. We will cover the nipple area because quite often we can get discharge from that area, and it could be a source of infection.
This lady first noticed some problems in her left side. A couple of months after that she noticed she had a lump developing on the right side, for which she then had biopsy that we can see. We can see a scar on the breast from where she had that. Fortunately it came back as being benign. Then subsequently, when she heard about this problem with PIP implants, she decided to go ahead and have them removed.
She has had further lumps on the right breast here, which I am also going to remove at the same time, and a third one in the axilla.
I’m just marking the incision which is just along the previous scar. We measure that and it’s quite a nice well-healed, well-settled scar that she has, which is about 5 centimetres in length. So I will probably stick to the same scar.
What I’m trying to do is to remove the implant intact within the capsule so as to avoid any spillage of silicone if the implant has ruptured. What I’m finding is that the capsule is pretty thin walled, and having released the capsule at one point, there is silicone that has spilled into the capsule. The implant seems intact. It’s not ruptured, but there’s a considerable amount of silicone bleed that is actually onto the surface of the implant as you can see there.
Can you see this? These are what are called silicone granulomas that she has formed where the lymph nodes have picked up the silicone that has probably leaked out from the implant into the tissues.
This lady to begin with had PIP implants that were 270 grams, but she also had an associated capsule around it, which I have circumferentially released, which does make the pocket slightly bigger. So to accommodate that pocket and of course she also did say that she wanted to go slightly bigger than what she was, so we’ve gone for a 300-gram implant on both sides, and these are Nagor implants.
One of this lady’s concerns was the fact that her old implants stopped somewhere there, and there was a big gap between the two. So that is why we made a specific attempt at increasing the pocket there so she’s got better cleavage on the medial side now.
I put some Steri-Strips on to support the wound and then some waterproof dressings so that she can start showering in a couple of days without getting the dressings wet, and those stay on for a week and we then change them.
So these are the two PIP implants that we removed from this lady. As you can see, this is the left one. Both of them were intact. There were no ruptures. But if you compare the two, you can see that they are different colours. This is definitely darker in colour than the left one, and that is probably because of the fact that, as I said during the procedure, there was distinct evidence of much greater silicone bleed on the right side with a fair amount of free silicone within the capsule that had formed around the implant. The capsule on the right side was also much lighter than on the right, which was probably due to the fact because there was more silicone irritating the capsule from inside than the left. These were PIP 270 cc. I don’t know whether you can pick it up on the screen.