PIP Breast Implants Exchange Surgery in UK9th March 2012
My name’s Adrian Richards. I’m a plastic surgeon and the Surgical Director of Aurora Clinics. In this operation, I’m going to be exchanging some PIP implants. Our lady’s had them in for a number of years. She’s worried about the PIP issues, and she’s not sure about the integrity of the implants. So we’re going to be changing them and exchanging them for slightly larger implants. I’ll take you through each stage of the operation.
That is the old scar there. I’m going to remove the old scar. The first stage of the operation is to put local anaesthetic under the scar. This reduces the pain of the operation afterwards because there’s a local anaesthetic, long lasting, eight hour anaesthetic under the scar.
Then the next phase of the operation is just to remove the scar. I’m just doing that now. You get a better scar if you completely remove the old scar so you’re back to fresh, virgin tissue on both sides. I’m just removing the scar there. Forceps. That’s just all scar tissue I’m removing there. We’ll just discard this in a sec. That’s the sort of the deep, the white layer you can see there is the deep layers of the skin. The yellowy layer you can see coming through is the fatty layer.
It looks as if the implant is intact. You can tell pretty much straight away. But there is, I don’t know if you can see it, there is some fluid around it. Can you see that? Can you put the sucker on, please? I don’t know if you can see there is fluid around the implant, which we’ll just suck out. Can you see that fluid coming up? That is silicone gel bleed.
That’s the implant removed. I don’t know if you can see, it’s got a ridge on it. It’s sort of filling out now. But more importantly, can you see the silicone that’s come through? Most implants would be completely dry. This one, I keep saying it, but nearly all the PIPs we see have this silicone gel bleed, because we think that the PIPs are missing a layer and this allows silicone to come through. You can also tend to feel the later PIPs. They tend to be more, I don’t know how you describe it, more sort of firm, ripply. They’re not as soft as normal implants. They just don’t feel very good quality. I think that’s the problem with them is that the silicone just come through because they cut down on the quality of the implants.
I don’t know if you can see, that’s a 315cc PIP implant. We’ll store all that data. We give the implant back to the patient at the end of the procedure. Can we store that, please?
The next stage is to deal with the capsule to remove the bits that need removing to have a good wash out as well. The first thing to do is to wash all the silicone out and then deal with the capsule.
This implant is in front of the muscle. This is the muscle here. This is the pectoralis major muscle. Can you see it coming down here? If you have your implant behind the muscle, this layer is lifted up and the implant goes underneath, if you can imagine, underneath the muscle. But in this lady the implant is in front of the muscle.
I tend to wash the pocket out with a couple of solutions. The first one is chlorohexidine solution, which is sort of soapy which helps to dissolve any remaining silicone granules. It’s very effective for doing that. We do a few washes of that. Each one progressively removes all the silicone.
The next stage is just to put in this temporary sizer. The sizer is basically an inflatable implant which you can use just to . . . I think this lady would like a 360cc implant. We’re just going to test that by blowing it up to 360 here. If you just watch the cleavage there, it will just fill up slightly. I think that’s good. That’s a much better cleavage than on that side.
This is a Nagor IMP-MR 360 implant, which is slightly wider than the PIP implants she had, which I think will give her a good appearance. We’re going to unwrap that, and then we’re going to keep washing out just to be sure on this side we’ve gotten rid of as much silicone as possible.
I’m just going to clean the area where the implant’s going to be in contact with the skin with this sterile betadine ointment. Then we’re just going to put some gentamicin in the pocket here, which is antibiotic. It’s a very strong antibiotic.
Then just open the new implant, which is a Nagor, a UK manufacturer. We’re going to use a Nagor 360cc implant. Just lift it up there gently, Tess. There’s a special technique for getting this in.
This is a technique, dermal stitching, and you have to make sure you’re not, I don’t think, can you see that? The knots must be absolutely parallel to the skin. We’re doing reef knots, not granny knots. We don’t want granny knots because they slip. They’re more bulky. So it’s very important, as a surgeon, to get your knots sitting exactly neatly. You can see what I mean.Some knots are messy knots. We want very neat knots.
This is just a final sealing layer. Basically, you would glue the skin together there, which completely seals that, and no bugs, when this dries, no bugs will be able to get in there because it’s completely sealed. That’s just really helping the body seal it with [inaudible 6:03].
On the left side probably using a slightly smaller implant because our patient feels she’s slightly bigger on that side naturally. This implant I’ve cut down onto, can you see? Again, it’s covered in silicone gel. Again, quite a lot of gel bleed there on both sides.
I’m just going to take the implant out. Just let go there. Feels intact. Sorry, it looks a bit rough taking it out. Again, can you see it’s quite folded inside? Again, quite a lot of silicone gel bleed. I don’t know whether you can, can you see that slimy on my fingers? Again, it feels like quite a low quality PIP implant. They did vary an awful lot. These ones seem to have a thin skin. They’re ripply. I think the quality of them went down quite a lot. Then here we are with all this silicone gel bleed.
On this side, just to confirm the side, we will keep a measure of all of these. But it’s a PIP 295-65407211 implant with quite a lot of silicone gel bleed. I would classify that as about average amount of silicone gel bleed for the PIPs we’re removing at the moment.
There we go. This is a new Nagor implant. We tend to use Nagor or Allergan implants mainly. This lady has selected Nagor implants, which is the top UK breast implant manufacturer.