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Hello, my name’s Adrian Richards, I’m a plastic surgeon and the surgical director
of Aurora Clinics which is based here in the United Kingdom. Today I’m going to be talking
you through an operation I did recently on this lady who had breast implants inserted
in front of the muscle and which had gone hard, particularly on the right side. So she
had some discomfort and some distortion on that side. As you can see, the implant’s
pulled in. Here I am moving it and you can see it’s quite tight, not moving very well
and not very compressible. So the first stage of the operation is to
remove the old scar, here I’ve just drawing around it and here I’m just taking the old
scar tissue out so I don’t want to leave two scars, I just want to leave one scar,
hence the reason for removing that scar. The next stage, following removal of the scar,
is really to identify the implant and in this procedure, I’m going to perform a total
capsulectomy. So here I am with a cutting diathermy, just dividing through the tissue.
That’s the outline of the implant and I gently dissect around it, removing the whole
capsule which I’ll show you in a minute around the implant. This needs to be done
quite gradually with the electrocautery. So I’ve removed the implant and that is with
the surrounding capsule which is holding it very tight and I’m going to show you in
a minute, the capsule being removed. Here I am dividing the capsule and as you will
see, the implant will sort of spring out so the capsule was really pulling the implant
tight. The implant, you can see, had a small hole in it inside. As I’m releasing the
capsule, can you see how the implant really wants to get out and that’s why the implant
feels so hard when it’s inside the body. Here I am just demonstrating that the whole
of the capsule is removed and this is the capsule around the implant which has made
it go high and you can see how much smaller than the implant it is, hence the reason why
the breast has gone firm. The next stage is really, once I’ve cleaned
everything out, to insert an operative sizer, this is a temporary inflatable implant which
I place inside the breast cavity and then I can inflate it slowly with a syringe of
saline. So in this case, I inflated it and found the optimum fill volume of the breast,
slightly larger than the 290cc implants that were removed with the capsule so I replaced
them with 325cc implants. But I like this technique because it gives me a bit of flexibility
on the size of the implant and enables me to fill the cavity adequately. Here I am just
checking no bleeding blood vessels, very careful to do that and the next stage is to insert
a breast implant. As you can see, I’ve put Betadine, which is the brown material, on
the skin, I’ve put antibiotics inside the cavity to reduce any risk of infection and
then the breast implant is inserted and everything’s ensured that it’s just lying flat against
the chest. This picture just shows before, you see a
hard immobile implant and this is after the finish of the operation, much more mobile
and soft. So thank you for watching this video, I hope
it’s been informative and has shown you what a capsule looks like. If you’d like
any information about this form of surgery, any other form of breast surgery or indeed
any type of cosmetic or plastic surgery, please contact us either via the website which is
aurora-clinics.co.uk or via our phone number. Thank you very much for listening and watching
the video.