Ruptured PIP Implants Removal - A patient's journey16th January 2012
Adrian Richards: Abby, can you just tell me a little bit about your PIP implants and where they’re put in and what’s been going on with them really.
Abby: Yeah. I had them put in, in January 2008, and to be honest, I had absolutely no problems until what I saw on the news, and I just wanted to be sure that everything was okay. So I tried to get back in touch with the surgeon, but I had no luck with that and they told me to contact my GP. I did that, had an examination with the GP, which she thought was absolutely fine. But as one breast had slightly changed shape, not very much, but she just thought it’d probably be best I go for an ultrasound.
I did that, went to [inaudible 00:47] in February, where another breast surgeon examined me, said he didn’t see any signs of rupture or anything like that but thought an ultrasound would be the best thing to make sure everything was sound. When he did the ultrasound, it wasn’t, he only found out that the left breast was ruptured at first. He sent me for a stronger ultrasound, which showed that both PIP implants had ruptured.
Adrian Richards: So when you had your operation, did you know they were PIP implants?
Abby: No, I didn’t.
Adrian Richards: So how did you find out?
Abby: I only sort of looked through my paperwork and stuff when I saw all of this, sort of coming up on the news. I was just panicking there. I wondered what implant I had in. So I went to check, and that’s when I discovered it was PIP Implant.
Adrian Richards: Okay. Now how do you feel about the whole thing?
Abby: Extremely upset. Extremely angry. I mean, I paid a decent amount of money for my breast augmentation, and it cost me a lot of money that I saved and worked hard for, and now I’ve got to try and . . . all that sort of money just seems wasted to me. Yeah, I went to a good surgeon for a good breast augmentation, and that’s not what I feel like I received.
Adrian Richards: Yeah. Yeah. I understand. There are a lot of people in your situation at the moment. So physically, how do you feel? Do the breasts feel okay or . . .
Abby: Yeah, they feel absolutely fine. There’s no major change in them, and that was my biggest concern that when I found out they were ruptured, if I didn’t push for the ultrasound, I wouldn’t have known. There was no major change. There’s been some slight pain. I’ve recently had a baby, so I put it down to just breast changing during pregnancy.
Adrian Richards: Do you get pain in one side more than the other?
Abby: The left one, I seem to get more pain in. Yeah, I think that rupture is less than what the right one is ruptured.
Adrian Richards: Yeah. Now, with the pain, how would you describe it? How often do you get it?
Abby: It’s just sort of a shooting pain. It’s like a niggling pain that sometimes you just feel, oh, that’s quite uncomfortable, and it’s normally sort of, I would say really it’s every day, but some days I might not notice it and then other days I do.
Adrian Richards: Yeah. Okay. So what’s going to happen today, Abby, because obviously you just arrived, so what I’m going to do now, is we’re going to through some paperwork, have you sign some forms, and then I’m going to do some drawing on you and take some photographs.
Adrian Richards: So what we’ll do is take photographs now, and then we’ll take more photographs in six weeks, and we can give you those photographs.
Adrian Richards: Now, would you like to go a bit smaller or larger?
Abby: I wouldn’t mind going a little bit fuller, sort of a fuller shape. I would probably like to leave that to you. I don’t want to be huge, but I don’t want to . . .
Adrian Richards: So if we went little bit higher that would be okay with it.
Abby: Yeah. That would be fine.
Adrian Richards: Okay. so the plan today, what I’m going to do is I’m going to take away your old scar, and then I’m going to have a look at the implants, and then I’m going to wash everything out, clean everything out, and depending on the state of them, how much I need to, if I need to remove any tissue. Then what I’ll probably do then is, with a temporary sizer, which is a temporary implant which I blow up to show you, so we can gauge the best size to fill up, fill your breast tissue, give you that fullness. Then I’ll put some new Nagor implants in, which are sort of the best UK manufacturer, and then stitch it up. It shouldn’t hopefully be that painful because you’ve already had the stretch from the breast. It shouldn’t be as painful as the original operation.
Abby: Okay. Brilliant. Thank you very much.
Adrian Richards: Just prepping everything up now, and you never quite know what you’re going to find with a patient that had PIP implants. Although Abby’s had a scan, which implies that both implants are ruptured, you don’t know for sure what state they’re going to be in, and the scan, interestingly, shows that Abby’s actually got more symptoms on the left side, but it was the right side that the scan showed was the more major problem. So it’d be very interesting to see.
Now, I’m going to start from the right side. We’re just prepping up now. So my first stage would be to cover up the nipples with Opsite, which is a tape which just prevents any infection from the nipple. Then we’ll clear everything off. I’ll remove the scar, and then we’ll go down and have a look at the implants.
There’s some fluid. Can you see that fluid? [inaudible 05:20]
Can you see that fluid coming out? So we’ve got fluid around the implant there, and that does imply that the implant ruptured. I can actually see where the PIP implant was broken here.
I don’t know if you can see that. Can you see that’s where it is broken? So there’s actually a fracture on the PIP implant, just there? Turn it again please, Myra. Often the best way of doing this is just try and get as much out in one go as possible.
So that’s what I’m going to do now. I put my finger in, grab the implant. It’s in a real mess. There it is. Can you see that? Try and get the implant with as much stuffing if you can. There it is and that’s not in a good shape.
Number one, it’s [inaudible 06:55] upside down. So that actually came out upside down because the numbers are to the front. Now, if I look at the implant turning it over, I don’t know whether you can see that. The silicone mostly contained within it, but look, it ripped there. Look, that’s a bit of it. We keep this for the patient. It’s ripped here, and it’s also ripped there. So it was upside down and sort of split. You can see it was sort of like that.
Two problems, really, higher rupture rate because the shell is not high quality. The silicone it contains is not medical grade silicone, and we don’t exactly know what it’s going to do to the body. We don’t know what [inaudible 07:46] will do when it’s in the body.
Okay. I think we’re pretty much there now. I’ll keep going a little bit longer.
Assistant: [inaudible 07:58].
Adrian Richards: So this is a brand new Nagor implant. It feels much nicer than the PIP. I never liked PIPs, 420 cc’s. That’s the back plate. I’m going to make sure I put it in the right way and it is not upside down like that PIP was. As I mentioned, Nagor have been very generous that any patient with ruptured PIPs, they will provide a free set of Nagor implant, which is very high quality implants, I think, and also UK made. So you’ve got that extra bit of security.
Okay. So that’s all stitched up. I’ve stitched up three layers with 3-0 Monocryl for the deep layer, then the 4-0 Monocryl, then this running 5-0 PDS. Cess, could we just cut there? So that’s three layers. The next layer I’m going to do is I’m going to glue the skin. We use what we call Dermabond tissue glue. So I haven’t made any stitches any longer.
Cess, could you just put some traction on there? I haven’t made the incision any longer. I’ve just cut out the old scar basically, and with this PDS I’m hoping that the scars will be much finer in Abby this time. It’s a long lasting stitch.
So I think that’s good, I think that’s probably given her a C/D cup, not too big, more fullness here. So I’m pleased with that. I think that looks really good.
I just want to take out the old scar here. [inaudible 09:52], are you still there?
Assistant: I’m here.
Adrian Richards: I’m taking out the old scar.
So it is ruptured, but only quite a small rupture. That’s not too bad. It’s only quite a small rupture in the side. So that’s good. Good. But you can see, even with the small rupture, do you see how much material there was around there? See how much fluid there was around there. So we were expecting that to be a 310.
Okay. So what Cess is doing now is prepping the skin. A slightly bigger implant, 460 this side, because this is Abby’s smaller side. I’m just going to place this in the pocket. Sew everything up here with nice, absorbable stitches.
I think we’ve got result here. We got rid of those horrible old PIP implants, which had leaked, particularly on the right. Got bigger implants, more in keeping with Abby’s physique. We’ve tidied up the scar so she can have a better scar with that good subcuticular stitch. I freed up here immediately so she’s going to have a better cleavage.
Overall, I think she’s going to get really good results, and hopefully she shouldn’t be in too much pain or discomfort tomorrow because all I really have to do is just free up that bit there, which will cause her some pain. I’d just like to say thanks for everyone in the theatre.
So here we are. I’ve got the two implants. This is the one we took from Abby’s right side. As you can see, it’s really very, very ruptured. I don’t know whether you can see that, but the implant, number one, was upside down when it was inside Abby. It’s ripped in many different directions. It’s just a base plate, really, that’s intact, and the silicone is sort of lying free in Abby. So, it’s really difficult to put the implant together, but I suspect this has been ruptured for some time. It normally starts off as a small rupture and then spreads throughout the body of the implant.
Moving on to the other one, the other one wasn’t in such bad condition. Can you see the difference in the colours? So the one on the right is more yellowy. This one has a rupture, which in a couple of, one main rupture here. I don’t know whether you can see. I’m just going to squeeze some of the silicone out. Can you see? So, rupture there, quite a small rupture. That was the only rupture. This, I suspect, has only just ruptured. But they’re weak implants.
They’re not good quality, they fold. This implant on Abby’s left would have gone on to be like the one on the right with time. So that fold with Abby’s movements would have just got bigger and bigger.
So, overall, very good we did the operation. The right side was a real mess, completely fractured. I suspect this fractured first. This left side, just gone, is only going to get worse, and it’s a really good thing we removed it and as you can see, I’m going to show this to Abby, this is the remainder of her breast implants.
So, anyone who has got PIP implants, and if I had one, I would want it removed. I think anyone with PIP implants needs to think really carefully about whether they have them removed. If they’re ruptured, I think you certainly should think about having them removed sooner rather than later. If they’re not ruptured, perhaps you can leave them. We don’t want to get to this situation.
So now it’s the next morning after the operation. How are you feeling Abby?
Abby: I’m really comfortable. I had some sort of pain and stuff, but nothing that’s unbearable with pain killers. It’s been absolutely fine.
Adrian Richards: So we last talked to you before your operation, yesterday morning. Can you just talk me through what’s happened from your point of view since then?
Abby: I’ve been able to sleep much easier. There’s relief that the implants have come out and I feel much safer. I’m actually happier with these results, that we discussed a fuller shape and stuff. So that’s great as well, but it’s more the relief that the PIP implants are out.
Adrian Richards: So you had your operation. How did you wake up afterwards? Were you in pain when you woke up?
Abby: No, I was really, really comfortable when I woke up. I really stated the pain was zero. There was no pain whatsoever, and then it must have been when the pain killers were wearing off a little bit, there were some uncomfortable moments, but nothing that’s been unbearable at all.
Adrian Richards: Was it uncomfortable in the middle bit as well?
Abby: Yeah. That’s where it seemed to be most uncomfortable because, like you discussed, you sort of freed the middle up a little bit more so I could have a better shape. When I came back to the room, it just sort of stayed the same. There has been no really bad pains or anything at all.
Adrian Richards: That’s good. And how do you feel about the shape now?
Abby: They’re fantastic.
Adrian Richards: Can we just have a quick look?
Adrian Richards: So, how’s it changed?
Abby: Well these lines that you seem to put on, we noticed they were actually flat to my chest when you put them on yesterday, and that’s where my breast implants seemed to stop completely. So as you can see it’s just a much fuller shape, which I’m much happier with.
Adrian Richards: Great. So what I’ve done is I’ve actually gone up to the lines and put the inflatable implant in, we blew it up, little by little, and then you can see when we have that nice fullness there. I think your cleavage is going to be better and the fullness is going to be better.
Adrian Richards: And those marks, don’t scrub them off. They’ll wash off over the next week or so.
Abby: Not a problem.
Adrian Richards: They do go at the end.
Abby: Stay purple.
Adrian Richards: So any sort of advice you would give to anyone with PIP implants? You’ve been through quite a journey in the last couple of weeks?
Abby: I would just say get them out. Before I actually knew my PIP implants were ruptured, talking with my family and stuff, it was only the financial that made me worry. My parents just said, “Don’t worry about money. If you’re that worried about them, let’s just get them out.” But I wanted to see, as some people have been saying they are safe if they’re not ruptured, so I just wanted to see if mine were. Then when I discovered they were ruptured, it was just the immediate thought that they needed to come out.
Adrian Richards: Brilliant. So anyone who’s thinking about having them removed, how would you describe your experience?
Abby: My experience with you guys has been absolutely amazing. On the other hand, the company that I originally had them done, it’s quite a long waiting game. I’ve also just spoke to a friend who’s got to wait 10 days just for the results of whether she’s got PIP implants in, which it’s just the worry of it all too, and I’m just really happy with the results. Now I feel like I can get on with my life knowing that my breast implants are safe.
Adrian Richards: Brilliant. So you’re back home now?
Adrian Richards: Good. So we’ll see you. We’ve got a 24-hour helpline. If you’re worried at all, just ring the hospital and they get straight through to me.
Adrian Richards: And then we need to see you next week, just to check the incision just to trim the absorbable stitches and then we go from there.
Abby: Brilliant. Thank you very much. It’s been a pleasure.
Adrian Richards: Take care Abby.
Abby: Thank you very much.
Adrian Richards: Thank you for being such a good patient.