Replacement of Ruptured Left PIP Implant that was Undetected by an MRI Scan23rd July 2012
Hello, my name’s Adrian Richards. I’m a plastic surgeon, and in this video I’m going to be showing you a PIP replacement of a lady who had her PIPs inserted in 2005. She’s got a couple of problems. Number one, the breast feel like they’re tethered and pulling inwards, and they’re not lying naturally on the side. That’s sometimes caused by muscle contraction. I’ll have a look at that. MRI indicates that probably the implants are intact, and, again, we’ll have a look at that during the operation.
Our patient today has got implants which are under the muscle. They’re contracted and nipples moved out to the right. She’s got pulling, tethering of the implants here. What I’m going to do is I’m going to release everything, remove the implants, and probably move the implants in front of the muscle so we get a better cleavage and better fullness in this area here.
This implant, which is a 265cc implant, which has gel bleed. I don’t know whether you can see. Can you see these little droplets of silicone gel on the outside? And also it has deflated slightly in the top. I don’t know whether you can see that. The gel bleed sort of comes through on the outside and the top of the implant deflates. We get a sort of a rim in this area with deflation. So, overall, pretty average appearance for a PIP implant with gel bleed, coarse rim, and deflation at the top of the implant.
I’ve just gone down to the capsule here. Can you see this fluid coming out here? That creamy fluid, if you get that creamy fluid, that means the implant’s ruptured. Immediately we know that’s ruptured. Can you see that? Just adjust that slightly. Can you see that creamy fluid coming out of there? Can you see that better?
You know immediately the implant’s ruptured when you get this creamy fluid coming out. I’ll just suck it all away. We’ll send a little bit off for analysis. Can you see this fluid coming out now? Can you see it just dripping out? That is not normal to have around breast implants, almost like puss. Can you see it? And this is where the silicone mixes with body fluids and produces this horrible, sort of creamy puss-like material.
This lady didn’t know this implant was ruptured. Look at how much fluid we’ve got around it. It’s no wonder you might feel a bit unwell with this inside you. You see it just coming out. I’ll suck away all the rest. Clean it all away. Can you see? See all that fluid that was just lying around her implant, and it was more than that, which I’ll suck out in a minute. The next job is really to just clean everything out and remove the remnants of the implant, which I’ll show you in a second.
If you’ve got that creamy material in, we know that it’s ruptured. Can you see here? That’s where the rupture is. It’s a very small rupture. But can you see how you get a rupture on the rim? She’s got a rupture along the rim there, and then that’s the silicone gel within. She’s got just a small rupture there. Now that rupture will continue to get bigger and bigger until the whole implant will split, which is what we see in other implants. Very interesting. A very early rupture. The silicone leaks out, body fluids leak in, and that’s what gives you the creamy material inside the capsule. So an early rupture. I think our lady is very lucky today. But if you see this creamy material around the implant or in the implant, in my opinion, that is a definite sign that we’ve got a rupture as you can see there.
The next stage is just to clear all the remaining silicone away. Then we’ll change our gloves, change all the instruments, and put a sizer in. But first of all is to remove all the capsule, remove all the infected silicone for this lady.
I’ve cleaned everything out now. The reason our patient was getting the pulling from the side is this bit of muscle wasn’t released. This bit of muscle was here, and it was pulling the implant over. So I’ve released the muscle. The muscle wasn’t released in the first operation, and that is why it pulls across. I’ve released it, and then the implant will be able to sit further on the side where it should do, rather than being pulled in all the time by, this muscle contraction pulls it inwards. I’ve put a sizer in, and I’m going to go with a 285cc implant. I’ve cleared out all the silicone and the capsule, and now we’re just to go for slightly larger implants.
This is just the end of the operation. We’ve got a good cleavage and much bigger implant. And because, basically, the muscle which comes down here is the pectoralis major, the muscle that comes in here is the serratus anterior, and it hadn’t been released properly, so it was pulling all the time inwards. I’ve separated the muscles and given, hopefully, a better line here. And, also, done the same on the other side. This is the side that had the ruptured implant. I’ve cleared the whole area out, and we’ve got a better cleavage, a more natural appearance laterally, and hopefully that should give her the results she wants.
Thank you for watching the video. As you can see, our patient today had an ultrasound and an MRI, which showed that the implants were probably intact, and that’s because she only had a very early, small rupture, which is difficult to detect with an MRI. Now if we just have a look at the implants here, this is the right implant. So it’s 265cc PIP implant, Lot Number 20105-033. Now the one that was ruptured is the left side, so it’s exactly the same Lot Number 20105, but it just 035, so just a couple of numbers different on that side.
Let’s have a look at the right side. You can see the right side, very typical for a PIP implant deflation in the top and gel bleed, but otherwise normal.
Now as soon as I opened the left capsule, I knew there was a problem because of all that milky fluid that came through. You can see the milky fluid within the implant. So what happens is you get a small, let’s just see if we can find that rupture again. There it is. I don’t know whether you can see that again. If I just hold it up, maybe. Can you see it there? So this lady has got a very small break in the implant. That allows the body fluids to get in, silicone to get out. They mix and then they make that milky fluid. I’ve seen that on a number of occasions, and I’ve also talked to other plastic surgeons who’ve noticed exactly the same thing. So this seems to be the area of weakness around the rim. That, then, every time you move, gets a little bit bigger, a little bit bigger, a little bit bigger, until the whole implant opens up. The reason PIPs have a larger rate of rupture, we don’t exactly know. We just know they have. And our series is showing that approximately 25 percent of our patients with PIPs have got ruptures. And, again, this lady did not know she had a rupture, and an ultrasound didn’t show it. So a lot of patients with gel bleed, 25 percent with rupture. As you can see, there is a different colour because the body fluids get into the implant and turn it slightly yellow.
Overall, very interesting. Our lady had very similar batch number implants inserted at the same time. She had similar problems with muscle not being released adequately, which I’ve hopefully corrected. She didn’t know her left implant was ruptured, so it’s good she’s had it removed. I think it just highlights the risks of silent ruptures. The majority will be picked up by ultrasounds or MRIs, but occasionally one that is very early doesn’t get detected.
Thanks very much for watching the video. I hope you found it useful and informative. Please feel free to contact us at any stage if you’d like any more advice about PIP implants or any other type of breast surgery. You can contact us either via phone or via email. Thanks very much.