PIP Replacement with Implant Upsize and Nipple Uplift17th July 2012
Hello, my name’s Adrian Richards. I’m a plastic surgeon and the Surgical Director of Aurora Clinics. I’m going to be showing you an operation today in which I remove some PIP implants. The patient has also decided to go a bit larger and also have a breast uplift because her nipples are in slightly low position. So I’ll be taking you each stage of the operation, starting with removing the implants.
This is our patient today who’s got PIP implants in, but also has a low nipple position. So what we’re going to do today is exchange the PIP implants. So I will, first of all, remove the old scar, remove the PIP implants, have a look at those, and we’ll probably go a little bit bigger with the implants because our patient would like a bit more fullness. Then, because her nipples are in a low position, I’m going to lift them. So cut around the nipple, lift it to there, which I’ve measured before, and then this point like that, all this tissue is going to be removed and the breast tightened up like that. So what we’re hoping to achieve is bigger breasts with a tighter, lower portion.
The first stage is just to remove this layer of skin from the lower part of the breast because that’s going to be my new fold. Then I’m going to cut down here and remove the implant.
So now I’m just going to remove the implant. It feels pretty slimy. There we are. So it’s a gel bleed, as we’re finding. Can you see that on the outside? Lots of gel bleed. It’s difficult to see exactly what size it is, but it’s PIP 460 I think, 465. We will record all that in a second. But quite intact, quite a lot of gel bleed, as you can see. That’s because the lack of the protective layer, all very slimy. So we’re just going to wash everything out now and probably go for slightly wider implants.
Now I’ve taken the top layer of the skin off here. I’m going to divide along here, and that will free the nipple up to move to that new position, and then it’s a matter of tightening up the tissue here. So I’ll show you that in each stage, and then I’m just going to tighten it up and sew it up, which will give us, hopefully, a nice breast shape.
So I’ve done the uplift now and sewn everything up with absorbable stitches, so the nipple’s in a higher position and it’s going to give her a fuller breast with a higher implant.
This is just the end of the operation. We’ve got brown tape on the incisions. As I said, we’ve increased the size and raised the position of the breast, given her a better cleavage, and generally improved the appearance of her bust, I think. So the nipples are nice and round underneath there.
I’m going to show you the implants here. This is the right implant. As you can see, it had quite a lot of gel bleed, 465cc, high profile implant. This is the lot number. On this side, the left side, same size, different lot number. You can see the implants are intact, but as I always say, they are prone to rupturing. Can you see they’re very domed, high profile implants? The most important thing is that obviously they had gel bleed. So PIPs that I’m removing have much more gel bleed than I would expect on a normal implant. We think that’s because the impervious layer was removed from the implants, and that’s what’s causing the bleed. So it’s a really good thing that the implants were removed because I think that silicone would eventually be picked up by the lymphatic system under the arms. I think it’s also a good opportunity obviously to change the size of our patient’s implants and to perform an uplift procedure.