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Adrian Richards: Hello. Our patient today had 350 cc PIP implants inserted in
2004. She's got some swelling, particularly on the left side, and what we're going to
do today is replace the implants with Allergan. She has selected the TRM implant. Look at
the implant now. So we can see it is quite deflated, which is very typical of PIP implants,
and notice the silicone has all gone down to the bottom and not in the top. We've got
the rim here, which is where it would tend to rupture, and we've got a lot of gel bleed.
Can you see these stringy bits between my fingers? So we've used a sizer and worked
out that the implant we've removed was 350 cc PIP. We used the sizer, which is an inflatable
implant, to assess the best volume. We agreed it was 330 cc TRM, which is the lower of the
Allergan implants. That's in there, sitting well. It's given her a good cleavage. I don't
know if you can see less projection, much more natural look. So I don't know whether
you can see there. I've just opened up the capsule of this implant, and I can see this
free silicone lying there. The real giveaway is this creamy fluid around the implant. So
that means the implant is ruptured, and it's something to do with the PIP silicone in there
that produces this creamy fluid. Can you see that again? So I don't know whether you can
see this implant is badly ruptured. You see all the fluid and silicone just coming out
here. So how long has our patient had a [inaudible 1:52]? Aggie: The last 12 months. Adrian Richards:
So, for the last 12 months, we've had swelling in this side, and you can see this is the
reason why. The scan wasn't conclusive that it was ruptured, was it Aggie? Aggie: No,
it wasn't. Adrian Richards: So the scan in this lady did not show for sure that the implant's
lining was ruptured. It didn't say whether it was completely ruptured. But I can see
immediately here that this implant is ruptured. That's why the change. So I'm just sucking
out the fluid here. Can you see all this silicone? If you could just get this [inaudible 2:28].
So I'm just removing the implant. I can see it is a 350 cc implant. Can you see this back
plate is actually at the front? So the implant not only is it ruptured, it's upside down.
I'll just show you all the . . . so you can see the state of the implant. The shell completely
disintegrated here with that very characteristic creamy fluid. The silicone is quite cohesive,
but it is moved around quite a lot. It's lost its original shape. We'll look at the implant
a little bit more in a minute. We'll just have a look down here at the implants. We
focus in a bit. This is the right implant, deflated as we would expect from a PIP, loss
of volume at the top. The lot and batch number were 08204. So, 8204065 on the right. Now,
if we have a look at the left, we can see it was in a really different state, and it
is a different lot number. So this lot number is 9604. Different lot numbers we're often
finding. You can see the implant's really disintegrated. What starts off as a little
crack in the outside of the implant a year ago, then extends as the patient moves, extends
through the implant, and you can see that the implant tends to rupture. See how easy
it is just to split the implant. Once they go, they just completely rupture. It just
sort of completely splits. Can you see? So they really rupture easily once they get a
little crack in them. Obviously, you've got a lot of silicone inside, which is all free,
and we've got all that fluid there. Also the implant was upside down. So you can see this
implant was really in a terrible state when we removed it. We're going to just keep that
for the patient. So you can see really the differences between the two sides. Interestingly,
the ultrasound wasn't conclusive. It didn't show the implant was upside down. It did show
the cyst, which I removed, but it didn't show conclusively that the implant on the left
was ruptured. So I think the only real way, the most effective way, I mean ultrasound
is better than nothing. Then a MRI is better than an ultrasound at assessing integrity.
MRIs aren't always right, but normally are. I think the only way of really assessing whether
the PIP implant is intact is by removing it. A lot of the PIPs we're finding have got gel
bleed on them anyway. gdgc gdgc Hello Robin Normal.dot Robin Microsoft Office Word Hello
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