R&R: The Holy Grail of PIP Implant Removal

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Removal and Replacement has received a ton of media publicity with surgeons competing to offer special deals and ladies all over the forums comparing their results. If there’s no way you’d give up life with breast implants now, then picking R&R is a no-brainer. But you still have a lot of choices to make!

Type, Size and Technique
How much freedom you have to choose the size, brand, style and technique for replacing your implants depends largely on the surgeon or clinic you choose. Some only use certain brands, others charge more for particular styles and many cosmetic surgery groups set a ‘like-for-like’ policy where you can only have the same size implant put back in as the one which was removed. This is not particularly straightforward as PIP implants do not run in exactly equivalent sizes to other implant ranges Download our comparison chart of PIP Implants with Nagor Implants. It is well worth checking the rules for your chosen provider before you hand over any money committing yourself to surgery with them. The information below is just a guide – ultimately your surgeon is the expert: so long as you have picked a surgeon you trust then that’s half the battle won

R&R Implant Types
As an indicative guide, there are 3 main contenders in the implant brand stakes being used by UK surgeons to replace PIP implants:
• Allergan
• Nagor
• Silimed
(A few surgeons also offer Mentor, but this brand is more commonly used in America).

Within each of these brands there are a number of different implant ‘ranges’. Perhaps the most common ones being used to replace PIPs are the Allergan Natrelle Inspira (Responsive and Soft Touch) and Nagor Impleo ranges. These are known as ‘high-end’, top quality implants. Of course, you’ve heard all that before and had your fingers burned so how can you trust it now? UK surgeons are pretty much unanimously agreed that these ranges from both Allergan and Nagor are good. Both brands do make cheaper, budget varieties – the Allergan CUI and Nagor GFX, so be more sceptical about these. There was some doubt over Silimed implants for a while but, interestingly, Silimed implants have just received FDA approval in March 2012 (subject to ongoing research). The Allergan Natrelle Inspira ranges have FDA approval. Some people are less keen on Nagor because they only have a CE Mark, not FDA Approval…though Nagor are keen to point out that they are working on this and expect to be FDA approved before long. Nagor also argue that, as a UK based company (Allergan is American) obtaining a US approval mark was less of a priority for them: it’s up to you to make your mind up about this.

The Performance Test
The standard Surgeon Spiel is that there’s much of a muchness between Allergan, Nagor and Silimed implants at the top end of each range. Yet PIPettes on the forums do report differences both in their implants and in what they’ve been told at consultation about implant suitability:

Allergan Nagor Silimed
Many ladies advised Allergan is better for preventing rippling – particularly the Soft Touch
Proud to be a ‘Best-of-British’ UK-based company.
A “marmite” implant – some surgeons & patients love them, some really don’t! good for correction

Has FDA approval CE Mark Only. Not FDA Approved (yet!) Very recently FDA approved – still subject to ongoing research into longterm safety / effectiveness
The Soft Touch produces a firmer result which sits higher; the Inspira Responsive a more natural look that drops slightly like natural breasts
Offering free PIP implants for victims having R&R
‘Form stable’ so won’t lose shape – described as like a gummy bear. Good for those requiring revisions, with already stretched breast pockets
Allergan recommended to ladies wanting an extra high profile
Extensive range of sizes and profiles Some UK surgeons still refusing to use until more tests done into links between silicone shell coating and cancer
Allergan implants tend to be the more expensive option
Size charts not exact – particularly in terms of weights. Nagor’s explanation suggests these charts meant for surgeons, not public use
May be too firm, can cause longer scar and possibility of rotation
Approximately 1% rupture rate Again only 1% rupture rate (approximately)
Rumoured even lower risk of rupture, capsular contraction and rippling

Replacement Implant Sizes
Whether you’re happy to stay the size you were, want to go bigger or would love to be a little smaller…in reality, the size of replacement implant you can have may be dictated by your surgeon or cosmetic surgery centre. Due to the terms of the PIP implant replacement deals, some will only allow you to switch like-for-like, in which case your surgeon will find the closest size to the PIP implants that you had.

The best advice we can give is: don’t get too hung up on sizing. Some ladies let it take over their lives and the fact of the matter is that sizing is not an exact science. You can pour over implant catalogues and tell your surgeon until you’re blue in the face that you want to be a 36KK. But a size on one woman may not look the same on another and your surgeon may find, when they come to use the saline sizer on the day of your surgery, that the size you selected simply won’t fit into the breast pocket without causing undue damage or distortion. Good surgeons will also not make you a size that puts you out of proportion with the rest of your physique.

As a starting point, why not view the size charts from the key implant brands. Please remember that a number of these charts are not exact and whilst you should form an opinion of the size and type you would like, keep an open mind to your surgeon’s advice.

Allergan Catalogue
Nagor Catalogue
Silimed catalogue
Click here to download our PIP / Nagor size comparison chart

Techniques for Removing and Replacing PIP Implants
Good surgeons will be able to remove your PIP implants via the existing scar that you have from your previous surgery, whether this is under the breast fold or around the areola. This will minimize any new scarring. They will be able to thoroughly wash out any leaked silicone whilst removing the implant and, if necessary, release any capsules which may have formed. All this is as standard.

You may want to ask your surgeon if they can perform ‘en bloc’ technique for implant removal. The entire implant is removed still inside the scar tissue capsule surrounding it, to help contain any leaked silicone. This is a more complex procedure and one which not all surgeons do or may only offer when there is evidence that the implant is ruptured / badly leaking.

The two main techniques used for replacing implants are Over the Muscle or Under the Muscle. Over the Muscle implantation is generally recommended for ladies with more breast tissue, who perhaps need the bottom area of the breast filling out. If you cannot pinch more than 3cm of tissue at the top of your breast, then you are probably better suited to an Under the Muscle technique. This is a little more painful (due to having to move the muscle as well during surgery) but many PIPettes feel it produces better results. With Under the Muscle techniques you cannot usually see or feel the implant at the top of the breast, which occurs sometimes with Over the Muscle. A nice natural slope to the breast is also produced. Your surgeon will be able to advise on the best technique for you after a full consultation but do let him know if you have any strong preferences.

Uplift & Correction

Breast surgery is often not straightforward, particularly when it is corrective breast surgery like implant removal and replacement. Some surgeons and cosmetic surgery centres are therefore offering the option to have extra procedures performed at the same time, such as Breast Uplift surgery (mastopexy), nipple correction (reduction or scar improvement) and work to improve your areolas (the coloured area around the nipple. If you have uneven (asymmetrical) breasts, this can also be corrected during your PIP surgery by using two slightly different sized implants. Another option is Capsule correction which is generally performed as standard if your surgeon encounters breast capsules as they are operating.

All of these procedures are, unfortunately, likely to carry additional costs which can be considerable in some cases. Corrective surgery is complex and time consuming so it is an area which surgeons are likely to evaluate and quote for on a case-by-case basis. Because of this, do not ever feel pressurised into having any “add-on” surgery beyond your Removal or Replacement. Do, however, be open-minded to your surgeon’s advice: It is in their professional best interests to give you the best result aesthetically that they can, so they are not necessarily trying to con you by suggesting additional procedures. Read up in advance about which procedures they will incorporate into the PIP deal and don’t be afraid to ask.

As Uplift surgery is required so often when removing implants (whether you are having them replaced or not) many of the cosmetic surgery companies have put together a PIP package including Uplift at a slightly lower rate. Make sure to get a quote for this upfront if you think it is something you might be interested in. Do not automatically expect that work to correct asymmetry (unless your PIPs were two different sizes to combat a pre-existing problem) will be done without an additional charge; ditto for improvements to your nipples or for dramatically changing size and shape. It is always wise to get a written confirmation of the work that you agree in your consultation. Of course, you may decide on the day that you want something slightly different and should still be able to discuss this with your surgeon right up until the point of operation…but having the details on paper gives you both something more rigid to work from. This is particularly useful as often your mind is a blur in your consultation and you may forget what was agreed once you get home.

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