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bjbjlulu hello, my name is adrian richards.i'm a plastic surgeon and i'm the surgical director of aurora clinics. in this operation,i'm going to be taking you through each stage of an operation of a lady who had pip implantsplaced in 2008, and she suspects that certainly her right implant may be upside down. ourpatient today has got pip implants. they've been inserted via an incision here at thebottom of the nipple, but they're lying at different heights. one of the problems i oftenfind when people have had implants placed this way, it is very difficult to get themto sit exactly right. so this implant is sitting here. i'm just going to measure that. so thatis 8.5 centimetres from the fold there. on this side, sitting much higher, and that distanceis 8 centimetres. so i've got to lower the

fold by half a centimetre this side. insteadof going in this way, i'm going to do an incision here, which gives me much better control ofthe fold. the first stage is to make the incision, and then i'll show you the state of the implantsin a minute. can you see when i've just opened the implant, there's this fluid that i quiteoften see around these pip implants? i've just got some of the fluid here. i don't knowwhether you can see it. there's always fluid around them. you can see it sort of runningout of the area here. so i'm just going to suck it away now. sucker, please. that fluidis caused by silicone gel bleed. you get silicone on the outside of the layer of the implant,and then this fluid just sort of builds up. i'm just going to suck it all away now. seeall the fluid coming from around the implant

there? i'll just remove it all there. thenthe next stage is just to remove the implant, and i'll show you that in a second. i've justremoved the implant, and we suspected beforehand that it had flipped over. so it came out upsidedown. now it should have been placed this way with the flat surface against the chestand the convex surface outwards, but in this case it was upside down. this is a pip highprofile 310cc implant. we will record the lot number now. you can see the implant hassilicone gel bleed on the outside. not as much as normal actually, so not too bad. it'sintact. there was fluid around it, but obviously it was upside down. the next stage i'm goingto free up the pocket and modify the pocket and then put a slightly larger implant in.now i've got a temporary inflatable sizer

here, which i've shown in a lot of other videos.i can blow it up, and i think our optimum fill volume is about 460cc in this lady. idon't think i can go really much larger. we've definitely improved the cleavage with the460. this is a new nagor 460cc implant which i'm going to insert now, with new gloves on.i'm just going to clean the skin with betadine, which is antiseptic, just so that our implantcan't get contaminated, or certainly reduce the risk of contamination. can we put thegentamicin in, please, there? we're going to put antibiotics in so that the antibioticwill lie around the implant. i'm just going to sew up that implant now. on this side,this lady's fold on this side is much higher. this is the fold along that line there. soi'm going to lower it by an incision here,

free up here, so that the implant can liea little bit lower on this side, so it's more symmetrical with the right side. i'm justcutting gently down onto the implant. this implant also is upside down. can you see?i'm just removing it now there. so again the back plate is at the front. so again, theimplant was upside down, which will give distortion of the shape of the breast. it is unusualto find both implants upside down, i must say. the silicone gel bleed, can you see?i don't know whether you can. can you see that silicone gel bleed there, more on thisside? can you see the silicone on the surface? that is more than a normal implant. i'd saythis implant was probably in slightly worse condition than the other side, the one onthe left. now i'm going to clean everything

out and suck all the fluid out that was aroundit, and free up the capsule. this is the appearance at the end of the operation. i think you cansee she's got a much fuller, more natural breast shape, and also we filled out thatlower part there, so the implant is going to sit at a much better height. here are theimplants. i'm just going to show you each side as we got them out. can we have a lookdown at this side here, please? this is the right side. it's an intact pip high 310ccimplant, and we're keeping the serial numbers. now this implant was in quite good condition,although it was upside down. it was upside down. it gives you quite a characteristicdistortion of the breast. it was intact. it had moderate gel bleed as opposed to thisone, which again was upside down but again

is a pip 310. this one had much more gel bleed,and this is a later lot number. can we just go back to this one? this lot number is 31000,which had relatively little gel bleed. this one was lot number 61307, which had more gelbleed. at the moment, we're just getting together all the figures on the different types ofimplants to try and work out which lots have the most concerns. thanks for watching thevideo. a big thank-you to all the operating staff and the patient for allowing us to showit. if you have got any concerns about pip implants, please contact us either via emailor phone, and we'd be happy to discuss your concerns on the phone or in person if that'sconvenient for you. h*ef hoo, h*ef h*ef h*ef h*ef hoo, gdoo, hep- hz7? h*ef hoo, h*ef gdoo,hello, my name is adrian richards rjd1 normal.dot

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