Removal of upside down placed PIP Implants and Replacement Surgery24th February 2012
Implant Removal / Replacement
Hello, my name is Adrian Richards. I’m a plastic surgeon and I’m the Surgical Director of Aurora Clinics. In this operation, I’m going to be taking you through each stage of an operation of a lady who had PIP implants placed in 2008, and she suspects that certainly her right implant may be upside down.
Our patient today has got PIP implants. They’ve been inserted via an incision here at the bottom of the nipple, but they’re lying at different heights. One of the problems I often find when people have had implants placed this way, it is very difficult to get them to sit exactly right. So this implant is sitting here. I’m just going to measure that. So that is 8.5 centimetres from the fold there. On this side, sitting much higher, and that distance is 8 centimetres. So I’ve got to lower the fold by half a centimetre this side. Instead of going in this way, I’m going to do an incision here, which gives me much better control of the fold.
The first stage is to make the incision, and then I’ll show you the state of the implants in a minute. Can you see when I’ve just opened the implant, there’s this fluid that I quite often see around these PIP implants? I’ve just got some of the fluid here. I don’t know whether you can see it. There’s always fluid around them. You can see it sort of running out of the area here. So I’m just going to suck it away now. Sucker, please. That fluid is caused by silicone gel bleed. You get silicone on the outside of the layer of the implant, and then this fluid just sort of builds up. I’m just going to suck it all away now. See all the fluid coming from around the implant there? I’ll just remove it all there. Then the next stage is just to remove the implant, and I’ll show you that in a second.
I’ve just removed the implant, and we suspected beforehand that it had flipped over. So it came out upside down. Now it should have been placed this way with the flat surface against the chest and the convex surface outwards, but in this case it was upside down. This is a PIP high profile 310cc implant. We will record the lot number now. You can see the implant has silicone gel bleed on the outside. Not as much as normal actually, so not too bad. It’s intact. There was fluid around it, but obviously it was upside down.
The next stage I’m going to free up the pocket and modify the pocket and then put a slightly larger implant in. Now I’ve got a temporary inflatable sizer here, which I’ve shown in a lot of other videos. I can blow it up, and I think our optimum fill volume is about 460cc in this lady. I don’t think I can go really much larger. We’ve definitely improved the cleavage with the 460.
This is a new Nagor 460cc implant which I’m going to insert now, with new gloves on. I’m just going to clean the skin with Betadine, which is antiseptic, just so that our implant can’t get contaminated, or certainly reduce the risk of contamination. Can we put the Gentamicin in, please, there? We’re going to put antibiotics in so that the antibiotic will lie around the implant. I’m just going to sew up that implant now.
On this side, this lady’s fold on this side is much higher. This is the fold along that line there. So I’m going to lower it by an incision here, free up here, so that the implant can lie a little bit lower on this side, so it’s more symmetrical with the right side.
I’m just cutting gently down onto the implant. This implant also is upside down. Can you see? I’m just removing it now there. So again the back plate is at the front. So again, the implant was upside down, which will give distortion of the shape of the breast. It is unusual to find both implants upside down, I must say. The silicone gel bleed, can you see? I don’t know whether you can. Can you see that silicone gel bleed there, more on this side? Can you see the silicone on the surface? That is more than a normal implant. I’d say this implant was probably in slightly worse condition than the other side, the one on the left. Now I’m going to clean everything out and suck all the fluid out that was around it, and free up the capsule.
This is the appearance at the end of the operation. I think you can see she’s got a much fuller, more natural breast shape, and also we filled out that lower part there, so the implant is going to sit at a much better height.
Here are the implants. I’m just going to show you each side as we got them out. Can we have a look down at this side here, please? This is the right side. It’s an intact PIP high 310cc implant, and we’re keeping the serial numbers. Now this implant was in quite good condition, although it was upside down. It was upside down. It gives you quite a characteristic distortion of the breast. It was intact. It had moderate gel bleed as opposed to this one, which again was upside down but again is a PIP 310. This one had much more gel bleed, and this is a later lot number. Can we just go back to this one? This lot number is 31000, which had relatively little gel bleed. This one was lot number 61307, which had more gel bleed. At the moment, we’re just getting together all the figures on the different types of implants to try and work out which lots have the most concerns.
Thanks for watching the video. A big thank-you to all the operating staff and the patient for allowing us to show it. If you have got any concerns about PIP implants, please contact us either via email or phone, and we’d be happy to discuss your concerns on the phone or in person if that’s convenient for you.