Silicone breast implants exchange with breast lift, I

Part I, Video by plastic surgeon, Dr. Michael J. Brown, the Medical Director of The Loudoun Center for Plastic Surgery. This plastic surgery video expertly demonstrates the actual cosmetic plastic surgery for replacing breast implants above the muscle to below the muscle. This surgery also demonstrates a breast lift in Northern Virginia.

Implant Exchange with Lift

This educational medical video is on a woman who has had a previous breast augmentation with the breast implants placed above the muscle. She has gone on to have children and had her breasts enlarged over the past few years. She's requesting to have her breasts lifted and her implants exchanged and her implants placed below the muscle. Because of time restraints, this video is actually two parts. This is part one.

What you've seen is a reduction in the size of the areola at the patient's request. The initial injections were to place a numbing medicine as well as a vasoconstrictive medicine into her tissues to minimize the amount of bleeding and discomfort that the patient has. This patient is asleep on the operating table. At this point, what I'm doing is cutting away the redundant areolar tissue, which is the pigmented skin that is surrounding the nipple. The innermost circle is the new size of her areola.

This patient was awake when I made these marks initially and she approved the size of the areola. Part of this process is taking away the outermost layer of the skin, but leaving the deeper characteristics of the skin intact. This deeper tissue is called the dermis and it has a better strength layer than the fat. Therefore, we like to leave it in so that the sutures are held better and the patient will enjoy better wound closure with finer, thinner scars. In the plastic surgery world, we call this de-epithelialization.

The white area that you see is actually the dermis. The slight yellow tinting underneath that is actually the fat. After the areola has been de-epitheliazed and essentially had the redundant areola excised, our attention will shift towards removing the old implant and the old breast implant capsule. Because her breasts are so large, her breast lift will require not only the incision around the areola, but also the incision going down the breast. She will be left with essentially a lollipop like scar.

The pencil that you've seen me use is actually conducting electricity and the patient's tissues are treated with that pencil to control bleeding. We call that pencil the electro cautery. The electro cautery actually has two buttons on it. One is for cauterizing tissue and the other one is for cutting tissues. You're seeing me use the pencil in both techniques. The pencil actually has two buttons on it, and my thumb is alternating between the cutting current and the cauterization current.

The yellow you see is her breast tissue and fat. This current allows me to dissect through her tissues and find her implant capsule. Once I get down to her implant capsule, I can actually create a pocket or a surgical plane on the outside of the capsule. From this position, I can actually dissect her breast implant capsule away from her breast gland. In this particular surgery, we will actually be taking out her entire breast capsule. Because of the length of the surgery, this video has been edited so that it can appear on time restraining websites.

You can start to see the capsule, which has almost a blueish tint to it. That is a layer of her natural tissues, which have surrounded the breast implant with scar. At this point, you can see both the capsule, which is being grasped with the instrument, and the implant itself, which is right there. I'm about to deliver the implant out and the implant capsule. You can see that this patient had a wonderful response to the implant, and only formed a thin scar tissue layer, which is about the consistency of a balloon. The implant is intact, and that is a saline-filled implant.

Attention has shifted to the other side and the dissection has already been completed. Again, I'm showing the capsule being removed. This patient is having a complete capsulectomy or a complete removal of the scar tissue pocket. Below the electro cautery, you'll see the muscle jump. That's her pectoralis muscle. These implants were below the gland, but above the muscle. We wanted to leave the muscle down and only take out the scar tissue pocket.

Again, you can see it is a relatively thin, very pliable scar layer that is very well-tolerated by the patient. At this point, we have returned to the right side and are starting to elevate the pectoralis muscle. In the blue forceps, I am holding up the pectoralis muscle. Again, I am holding up the pectoralis muscle, showing you what we call the under the muscle plane or the subpectoral pocket. My finger can actually pass deep into that wound, and that's where her implant will be placed. That muscle layer gives her an extra layer of protection. At this point, she has two pockets. She has a pocket above the muscle where her old implant was, and a pocket below the muscle, which is where the new implant will go.

There is a space where the old breast implant used to be above the muscle. What you're seeing are sutures being placed in the pectoralis muscle that have been sewn to the breast gland itself. These sutures will in essence obliterate these subglandular pockets, so there's only one position for the implant to be in. Several of these sutures will be placed to prevent any implant malposition occurring.

At this point, both of the pockets have been prepared and the silicon gel implant is being placed in. These implants are pre-filled and her breast implants are placed below her muscle. She is now ready to proceed with the breast lift aspect.