Breast Enlargement following Infection

Mr Richards removes an infected breast implant and performs a Breast Enlargement 3 months later.  He discusses breast enlargement surgery and complications that can occur following breast Implants procedure. If you think you suffer from this condition, and you want to book a FREE consultation with our specialist plastic surgeon to discuss Implant Removal/Replacement, please call us on 01844 214362.

Breast Enlargement Following Infection

Hello. My name is Adrian Richards. I’m a plastic and cosmetic surgeon and the Surgical Director of Aurora Clinics based here in the United Kingdom. Today I’m going to be taking you through a very interesting case of a lady who had a breast reduction procedure performed in America some years ago. Subsequently had a breast enlargement procedure and uplift performed in Turkey. She was initially happy with the results, but unfortunately she developed an infection around the implant of the left side. This infection went down to the implant. So I unfortunately had to take the implant away. Then when she was cleared of the infection, I performed a breast reconstruction, inserting a new implant and releasing the scarring. So I’ll take you through how she was when I initially saw her and then each of her operations until the final operation which was performed today.

Here we can see the appearance of the left breast when the lady first came to see me. You can see there’s a sloughy wound with a lot of necrotic material at the bottom there.

What we did initially is we cleaned the wound, and it soon became apparent that the implant was visible at the base. So if you look in there, that area shining back, I’m just poking here, is the implant. Once the implant is exposed like that, it really has to come out because the body can’t fight an infection around an exposed implant because there are bugs getting in all the time. You can see here’s there’s some fluid around the implant which signifies it’s infected. The only real way of treating this is by removal of the implant. I’ve extended the hole and I’m just removing the implant. As you will see, it’s a smooth silicone gel implant of 260 ccs. I’m going to remove it and then dress the area until it heals as this is the only real option in this case.

Here we can see the appearance three months after the removal of the implant with quite a lot of breast asymmetry. In particular, the nipple to fold distance on the right is significantly longer than the left. I’m going to reduce this as I’ll show you in the operation. On the left, there’s a lot of tethering and shortening from the infection where the implant was exposed previously. That divot is the healed opening that I removed the implant from.

I’m going to start the operation on the right. You can see the makings here as I turn the patient are on the right. The area between those lines is the area that I’m going to remove because, as I mentioned, I’d like the nipple to inframammary fold distance to be five centimetres on this side similar to the other side.

This area here which I’m shading is the skin I’m going to remove to achieve better symmetry and a reduction in the length of the lower part of the breast.

What I do is I just incise partly through the lower part of the skin I’m going to excise. Then I just go through part of the skin on the upper part here. Between those two lines, I will remove the top layer of skin in the shaded area.

I just very gently start removing that top layer of skin aiming to leave intact the lower area of skin.

Here’s that’s done, and that’s me just pressing on the implant. Here I am just cutting down with my electrocautery onto the implant to remove it. You’ll see that the implant is a smooth implant exactly the same as I removed previously on the left side.

My next stage is just to extend the pocket because, remember, I’m going to try to sew the base of the breast down to the chest wall so I’ve got a secure inframammary fold. To do that, I need to open up the pocket very widely, as I’m doing here, to allow me to complete that stitching which I’ll show you in a minute. Here I am just opening up the pocket. Obviously this is a much larger incision than you’d ever use with a normal breast implant. I just am going to free up the pocket a little bit because I’m probably going to use a larger implant than the 260 cc she had.

The next stage is to secure the upper and lower fold of skin to the chest wall so I can secure my inframammary fold, because I don’t want the inframammary fold rising up onto the lower part of the breast. I’ll do that in three layers with absorbable stitches as I’m showing you here. I leave a hole for the implant. You can see as I press down there how secure the inframammary fold is there.

This is my sizer implant, which is a temporary inflatable implant which I’m going to insert into the cavity. This just lets me really fine tune the volume of the implant that I’d like. So I inject into it 50 ccs at a time. It gets slightly larger until I get an optimum fill for this lady’s breast, which in this case was 420 ccs, which is quite an increase from the 260 ccs she had previously.

Here I am putting some iodine ointment on the skin, changing my gloves to reduce the risk of infection. I insert the implant and I’m putting some antibiotic around the implant, again, to reduce the risk. There’s the implant just being inserted. I’ll insert it and then sew the area up in three layers. The first layer is securing the fold and then further layers to the skin.

This is just before the final layer which I’m going to insert now. You can see how secure the fold is there to the lower part of the breast. This is just the ends of the stitches. They’re the only stitches that need to be removed from that side. You can see that the fold is actually secured to the chest and a good stable breast base.

This is the final layer of closure, which is a tissue glue just to make the wound nice and waterproof and reduce the risk of any infection.

Now on to the left, you can see there is quite a lot of tethering still there where I removed the implant, where the infection was on the left. I’m freeing that up with some scissors. I’m using a technique called hydrodissection. In this technique, fluid containing antibiotics and local anaesthetic is infiltrated just to help me develop that pocket where I’m going to put my implant.

Here I am incising the inner part of this lady’s scar and then using my electrocautery to separate the breast tissue from underneath. There’s really quite a lot of tethering under that sinus where the implant was exposed.

Here I am just putting my temporary implant in there. I’m again going to blow this up to just double check that the volume is good on that side. Again, I’ve just released quite a lot of tethering and scarring from underneath that depressed area.

I like to irrigate the area just to remove any bugs or any bit of tissue that might remain. Again, iodine. Again, same implant as on the right side of 420 ccs cohesive gel textured implant which I’m using in this case.

Again, there’s the implant, and this is me just inserting it nice and gently. This is a cohesive gel which will maintain its shape.

Here I am just checking the tethering has been released satisfactorily. It’s still tethered a little bit. I don’t want to release it anymore because I might endanger the viability of the skin there.

Here I am just doing my skin closure again with absorbable stitches there, and again I’ll use a subcuticular suture to clear everything up.

This is the appearance at the end. A 420 cc implant increased from a 260 cc, and I think quite good symmetry on both sides.

Thank you very much for watching this video. I hope you found it useful and informative. If you’d like any information about this or any other procedure, please feel free to contact us either via our website or by phoning us on 01844 214362. Thank you.