Mastopexy with Explant of Implants - Dr. Juris Bunkis



Juris Bunkis: Today we're doing an operation which is becoming more and more common in Orange County Plastic Surgery. This lady had breast implants placed many, many years ago, has gotten older, gained a little weight. Now her breast is too big for her and too saggy, and we're gonna remove her implant completely and do a lift. I will show you the implant coming out and I will show you the new breast. Afterwards we'll show you some before and after photos.

Okay, we've made our initial cuts. We use a little cookie cutter to get the same size areolas on both sides. We're trying to save about 42 millimeters for the size of the areolas. This is all the skin that we're going to remove and, once the skin is removed and the implant comes out, you'll see that this will come together, like so. This part gets removed, so this will be taken out so the breast will be much more uplifted. 

Okay, we have removed the excess skin, as you can see. Now we're gonna undermine this area so that this moves down and we're gonna move the nipple up. The next thing I'm gonna do is take out the old implant. Here we just cut the breast tissue until we get down to the pocket. As you can see, she has a fair amount of breast tissue. In a lot of thinner gals we'd already be in it. When you get to it, you can cut the lining of the scar tissue with this cautery without damaging it. You open the pocket a little more and you can pull out the implant, and you can see it's in good shape, but she still has plenty of breast tissue. 

Okay, we have finished the dissection here. You can see we've elevated these flaps. The nipple is going to be pushed underneath here, come out in the right place. Now we're gonna bring the flaps together before we start sewing them. We use a little towel clamp, just to temporary hold the skin in place until we put in the final sutures. This lines it up for us and gives me an idea of what we're gonna have.

Speaker 2: You need one more?

Juris Bunkis: One more, please. And one more. Now you can see how it's starting to line up. Okay. Okay, here we've brought the flaps together with a few sutures. We'll put in a lot more, of course. Now we're going to make the opening for the areolas, and that will be right here. You can use a little template so that we get a nice, round circle. Now we'll make the opening for it.

Here you can see the nipple waiting for us in its new position. This is where we're going to sew it in. Okay, we're all set. I just finished the second side and, as you can see, the areolas has been moved up to a new position. She has an upside down T scar and now the nurse, on this side, is starting to put on some Dermabond, which is a glue. In the old days we used to put little tapes across the incision, called Steristrips. Those couldn't get wet for a week and so forth, but this glue that we're putting on, the very next day the patient can take a shower. This is how we remove breast implants and do breast lifts at Orange County Plastic Surgery.

This lady in her 40s had had implants placed and a small lift just around her areolas about 15 years earlier. She gained a little weight and she just felt her breasts were too big for her. You can see she's got a lot of fullness in the top and she just wanted them out and to have a lift. Here you can see her afterwards, how now she has a circle around the areolas and an upside down T just like we saw in the operating room. That's what we're trying to achieve.