PIP implant removal | replacement | what are my options?

PIP implant removal | replacement | what are my options?

PIP implant removal and replacement – The options?

It is quite clear that most patients with PIP breast implants want to have them removed. This follows the recent revelations that the manufacturing company, Poly Implant Prothese (now bankrupt) was using non medical grade silicone and that the implants are likely to have a much higher rupture rate than other silicone implants. The current advice is that patients who are symtomatic or who have evidence of rupture/ leak, should undergo PIP implant removal. There remains no evidence of any risk to health.

For patients who are asymptomatic and have no evidence of rupture/ leak, there is no firm recommendation that the PIP implants should be removed. We are advising prophylactic removal/ exchange for such patients and for our own PIP patients this will be carried out free of charge at the Spire Murrayfield Edinburgh.

For the official UK guidance from the major medical organisations please follow this link: Joint surgical statement on clinical guidance for patients, GPs and surgeons

We have seen and reviewed over 80 patients with PIP breast implants since they were withdrawn from the market in 2011. We had stopped using them ourselves in 2007 following concern about the implants. This blog aims to summarise the treatment options that our own patients have been offered and provides information to women who are naturally concerned about their own choices.

The choice you make regarding your PIP implants will depend on several factors such as, evidence of rupture, whether or not you are happy with your current breast size and shape etc.

OPTIONS FOR PIP IMPLANT PATIENTS

1. Clinical examination, scan, and regular follow up

Clinical examination and imaging (Ultrasound/ MRI Scan).  Women with no evidence of implant failure who choose to keep their implants may be offered an annual review and a routine MRI Scan every 2 years. It is important to note that clinical examination and imaging may detect the majority but not all implant failures.

2. Explantation

Some patients may wish for their implants to be removed and not replaced. This is called explantation. Generally speaking this is not the best cosmetic option as the breast envelope has been stretched and removing implants (and not replacing them) may leave the breasts looking saggy and wrinkly.

3. Exchange like for like

If you are happy with your current breast size then the implants can be exchanged ‘like for like’ with the same volume implants from another manufacturer. This is the most commonly requested option.

4. Exchange and upsize

Some patients have been requesting larger volume implant replacement. This is sometimes necessary to address slight droppiness of the breast that may have occurred with time/ ageing/ pregnancy. Often upsizing is requested as a matter of personal preference by the patient.

5. Exchange and additional work to address changes that are clearly not related to the type or integrity of the implant

Some women have intact implants (no rupture) but are unhappy with certain aspects of their breast implant surgery. There may be capsular contracture, asymmetry, rippling or other cosmetic issues that are common to ALL silicone breast implants. In such cases, exchange of the PIP implants will require additional surgery to address these other cosmetic/ physical concerns. See section on revision breast augmentation.

6. Exchange and uplift (mastopexy)

Some women have excessive droopiness (ptosis) of their breasts following their previous implant surgery. They may require a breast uplift during their exchange (augmentation mastopexy). There are likely to be extra charges for incorporating an up lift procedure.

7. Exchange + additional procedures not related to breast

Any of the above options + additional “non-breast” procedure while under anaesthetic.

Please note :

A. Options 2-3 would include surgical removal of the lining of the implant pocket (capsulectomy) if required. Removal of silicone/ related lumps and enlarged lymph glands may be considered if they are causing significant problems.

B. There are no charges (for patients who had their original surgery at a Spire Hospital) and no time limit for patients choosing option 1, 2 or 3 assuming that the initial surgery was carried out at a Spire Healthcare Hospital.

C. Patients choosing additional work as in options 4-7 will incur professional fees and/ or hospital charges.

The options discussed above a purely the personal opinion of Awf Quaba – Consultant Plastic Surgeon – Edinburgh – They are in keeping with the guidance of the British Association of Aesthetic Plastic Surgeons (BAAPS).