best plastic surgeon breast augmentation
bjbja my name's adrian richards. i'm a plasticsurgeon and the surgical director of aurora clinics. in this operation, i'm going to beexchanging some pip implants. our lady's had them in for a number of years. she's worriedabout the pip issues, and she's not sure about the integrity of the implants. so we're goingto be changing them and exchanging them for slightly larger implants. i'll take you througheach stage of the operation. that is the old scar there. i'm going to remove the old scar.the first stage of the operation is to put local anaesthetic under the scar. this reducesthe pain of the operation afterwards because there's a local anaesthetic, long lasting,eight hour anaesthetic under the scar. then the next phase of the operation is just toremove the scar. i'm just doing that now.
you get a better scar if you completely removethe old scar so you're back to fresh, virgin tissue on both sides. i'm just removing thescar there. forceps. that's just all scar tissue i'm removing there. we'll just discardthis in a sec. that's the sort of the deep, the white layer you can see there is the deeplayers of the skin. the yellowy layer you can see coming through is the fatty layer.it looks as if the implant is intact. you can tell pretty much straight away. but thereis, i don't know if you can see it, there is some fluid around it. can you see that?can you put the sucker on, please? i don't know if you can see there is fluid aroundthe implant, which we'll just suck out. can you see that fluid coming up? that is siliconegel bleed. that's the implant removed. i don't
know if you can see, it's got a ridge on it.it's sort of filling out now. but more importantly, can you see the silicone that's come through?most implants would be completely dry. this one, i keep saying it, but nearly all thepips we see have this silicone gel bleed, because we think that the pips are missinga layer and this allows silicone to come through. you can also tend to feel the later pips.they tend to be more, i don't know how you describe it, more sort of firm, ripply. they'renot as soft as normal implants. they just don't feel very good quality. i think that'sthe problem with them is that the silicone just come through because they cut down onthe quality of the implants. i don't know if you can see, that's a 315cc pip implant.we'll store all that data. we give the implant
back to the patient at the end of the procedure.can we store that, please? the next stage is to deal with the capsule to remove the bits thatneed removing to have a good wash out as well. the first thing to do is to wash all the siliconeout and then deal with the capsule. this implant is in front of the muscle. this is the musclehere. this is the pectoralis major muscle. can you see it coming down here? if you haveyour implant behind the muscle, this layer is lifted up and the implant goes underneath,if you can imagine, underneath the muscle. but in this lady the implant is in front ofthe muscle. i tend to wash the pocket out with a couple of solutions. the first oneis chlorohexidine solution, which is sort of soapy which helps to dissolve any remainingsilicone granules. it's very effective for
doing that. we do a few washes of that. eachone progressively removes all the silicone. the next stage is just to put in this temporarysizer. the sizer is basically an inflatable implant which you can use just to . . . ithink this lady would like a 360cc implant. we're just going to test that by blowing itup to 360 here. if you just watch the cleavage there, it will just fill up slightly. i thinkthat's good. that's a much better cleavage than on that side. this is a nagor imp-mr360 implant, which is slightly wider than the pip implants she had, which i think willgive her a good appearance. we're going to unwrap that, and then we're going to keepwashing out just to be sure on this side we've gotten rid of as much silicone as possible.i'm just going to clean the area where the
implant's going to be in contact with theskin with this sterile betadine ointment. then we're just going to put some gentamicinin the pocket here, which is antibiotic. it's a very strong antibiotic. then just open thenew implant, which is a nagor, a uk manufacturer. we're going to use a nagor 360cc implant.just lift it up there gently, tess. there's a special technique for getting this in. thisis a technique, dermal stitching, and you have to make sure you're not, i don't think,can you see that? the knots must be absolutely parallel to the skin. we're doing reef knots,not granny knots. we don't want granny knots because they slip. they're more bulky. soit's very important, as a surgeon, to get your knots sitting exactly neatly. you cansee what i mean.some knots are messy knots.
we want very neat knots. this is just a finalsealing layer. basically, you would glue the skin together there, which completely sealsthat, and no bugs, when this dries, no bugs will be able to get in there because it'scompletely sealed. that's just really helping the body seal it with [inaudible 6:03]. onthe left side probably using a slightly smaller implant because our patient feels she's slightlybigger on that side naturally. this implant i've cut down onto, can you see? again, it'scovered in silicone gel. again, quite a lot of gel bleed there on both sides. i'm justgoing to take the implant out. just let go there. feels intact. sorry, it looks a bitrough taking it out. again, can you see it's quite folded inside? again, quite a lot ofsilicone gel bleed. i don't know whether you
can, can you see that slimy on my fingers?again, it feels like quite a low quality pip implant. they did vary an awful lot. theseones seem to have a thin skin. they're ripply. i think the quality of them went down quitea lot. then here we are with all this silicone gel bleed. on this side, just to confirm theside, we will keep a measure of all of these. but it's a pip 295-65407211 implant with quitea lot of silicone gel bleed. i would classify that as about average amount of silicone gelbleed for the pips we're removing at the moment. there we go. this is a new nagor implant.we tend to use nagor or allergan implants mainly. this lady has selected nagor implants,which is the top uk breast implant manufacturer. [content_types].xml #!mb ;c=1 _rels/.relstheme/theme/thememanager.xml sq}# theme/theme/theme1.xml
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