breast augmentation vs breast lift

hello, my name’s adrian richards, i’ma plastic and cosmetic surgeon and the surgical director of aurora clinics based in the unitedkingdom. today i’m going to be talking you through an operation i did on this lady whopreviously had implants inserted under the muscle. as you can see from these profiles,the implants are very high with the breast being rather low and this leaves an effectknown as the double bubble effect with the upper bubble being the implant higher andthe lower area being the nipple. what i’m doing in this case is performingan uplift procedure, this is the skin i’m going to remove and i’ll lift the nippleto that new position there. so the first stage really is to remove her implant and i’mgoing to do that through this incision here.

so the first stage really is to remove thetop layer of the skin over that incision and the reason for this is it gives me a goodlayer of skin to stitch to. so this is an area of de-epithelialised skin and i’m goingto cut through that to remove the breast implant. so here i am just cutting through that layer,through the fatty tissue which is typically yellow and then this is the implant whichi have removed, it’s a low profile implant but intact on that side. next stage reallyis to irrigate everything, to remove as much silicone as possible, there will be some siliconegel bleed which i’m removing. my next stage is just to release the lining around the implant,the capsule, just to make sure everything’s free. i then insert the temporary inflatablebreast sizer, this is going in now and then

i inflate that to the patient’s desiredvolume, just to check that it all fits well. you can see me here just inflating the implantand i’m just checking here that everything’s sitting well and that the breast is inflatednicely. so i would inflate this until we’ve got a good inflation of the breast and theni would remove it and insert the permanent implant, this is just temporary. so here iam, quite happy with the size of the breast now, i’ll remove the inflatable sizer andthe next stage, now i’ve ascertained the correct volume, is to insert the implant.so i’ve put antiseptic betadine, this is the brown lotion on the wound, i change mygloves, this is to try and make sure everything is absolutely as clean as possible when theimplant goes in. so we’ve got antiseptic

on the skin, i’ve put antibiotics actuallyaround the implant to reduce risk of infection, this is the antibiotics just going in here.so these antibiotics will actually lie around the implant, reducing the risk of infectionand possibly also the risk of capsular contracture. this is the implant and i’m just going toinsert it now and there’s a technique to doing this through a small hole. obviouslywe want to make the incision as small as possible and that’s the incision just going in, ijust check that it’s absolutely lying flat against the chest there. the next stage isto sew up the incision, i’m doing that in three layers and i’m using that layer ofskin which i took the top layer off as a secure closure there. you can see the implant isnice and secure and hidden in there.

the next is to perform the breast uplift procedure,i’m just going to check my marks here by inserting temporary stitches. these are calledtailor tacking stitches, i just put three or four in temporarily just to hold the breasttogether and that allows me to just make minor adjustments to my plans. so i’ve made markingson the skin but i can adjust them just to make sure the scars are going to lie exactlywhere i want them with this tailor tacking technique. i then take the top layers of theskin off between my marks and then free the nipple up by dividing beneath it, as i’mdoing here. you can see with the cutting diathermy, i’m just dividing around the nipple frombelow and that allows the nipple to rise up. here i’ve sewn the nipple in its raisedposition and here i’m just pulling gently

the skin together to give the final appearance.here you can see i’m just sort of drawing the skin together.so the next stage really is to put some deep absorbable stitches in the area to hold itall together and the tension should not be on the superficial layers of the skin, itshould all be taken up by deep layers, deep stitches within the breast tissue. here youcan see i’ve put my multiple layers of stitches in and i’m just insetting the nipple herewith absorbable stitches. again, there should be no tension on the skin as this causes badscarring. so here we are, i just need my final layer of stitches now which is a subcuticular,that’s a buried running stitch which you shouldn’t see and the final closure is withsome tissue glue which i’m just putting

on here. this allows you to wash and bathevery soon after the operation because the wound is sealed. you can see with my lefthand there, i’m just holding on the end of a stitch and that’s the only stitchesthat are going to need to be removed. i don’t used clips and i don’t use those old fashionedcross stitches which can be very painful to be taken out.the final stage is to put some tape on the scars, just to support them and i like thepatients to wear this for about six weeks. here you can see on the right, implant andintact. on the left, when i came to take it out, you could see that the implant was ruptured.i’ve got free silicone here, you can see the implant’s been in for approximatelyten years, i’ve got free silicone and a

ruptured implant. it’s very important inthat case to wash out very thoroughly. here you can see this is pre-op appearance, thisis immediate post-op appearance. this is pre-op again with the nipple higher and again afterwards,a bit lower. this appearance was taken at one week, this is the appearance of the scarsat one week. so thank you very much for listening and watchingthe video, i hope it’s been informative. if you’d like any information about anyof these procedures or would like to contact us, please do so via the website or by phoningus on our uk number. thank you.