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Adrian Richards: Our patient today had PIP's inserted
in front of the muscle in 2008. What's interesting about her is the incision used was under the
areola, which is the brown area around the areola, and so we're going to be exchanging
the implants during this operation via the same incision. She is a little bit asymmetrical,
she was a bit pre-operatively before her first surgery, so we aim to improve that during
this procedure.
Our patient today, her implants were put in by this incision, which has healed very well.
She'd like us to use that again, so we're going to use that again in this case. So I'm
just going to incise here and I'll show you this approach in just a second.
I've just gone down to the implant and noticed all this creamy fluid around it, which means
it's likely to be ruptured. Can we have the suction on please. I'm just removing, sucking
away some of the infected - the inflamed [sounds like 01:10] material, and I'll show you that
in...
You can see there's a rupture here, which is responsible for the creamy fluid. Just
a small one around the back of the implant, just here, just there. So now I'm going to
clean everything out and put in a larger implant.
Maya [sounds like 01:27], can you just hold the retractor just for a second while I...
That's great, now I'm just going to put the sizer in, which is a temporary inflatable
implant. Which we're just going to place into position.
There we go, let go there, Maya. And now we're just going to blow up. So we removed a 305cc
implant from this side. We're thinking perhaps to go 365. That's 100, 150, 200. You can see
the way it fills up. 200, 250, 300, 350, 365, it's going to be pretty good for her actually.
So that's 365, just there. That's a bit fuller, that's what she wanted, 365 I think is what
we're going to go for.
I've just sewn up the incision, now I'm just gluing it. This is just an extra sort of layer
of security we use to just make sure everything is waterproof, and no bugs can get in. That's
it, I think you can see she's got a better volume on this side. Slightly more profile,
and without scarring underneath which is good.
So I've just dissected down onto this implant here, and you can see again this implant is
also ruptured with this gel and fluid. So I'm going to remove the implant now. I'm just
sucking all around the implant here. And you can see, I can see the ruptured implant here.
This is all fluid and silicone I'm sucking up. I'll show you the implant in a second.
... just removed from the left side, you can see more severely ruptured than the right.
It's a very classical appearance for a PIP. I'm just going to clear everything out and
take the capsule out.
We're at the end of the procedure. You can see we have brown tape over the incisions.
I think we've got much better symmetry between the two sides. Hopefully a much better appearance.
I'm going to show you the implants now. Let's look at the right and the left. This is the
right one. You can immediately tell it's ruptured because it's got the creamy material inside
it. Let's look again for that little rupture, there it is. Can you see? If I just hold it
there you can see that little rupture there on the back of the implant, a small rupture.
If they're small that means they're relatively recent. There's not that much contamination
of the body fluids and the silicone within the implant. On the left you can see it's
much more yellowy, much more severe rupture, which has happened much earlier I think, and
it may be that the rupture happened around the baseplate here of the implant. Can you
see the baseplate here? That seems to be an area that some do rupture in. You can see
the implant is completely opened up like a clam really.