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Dr. Linder's Blog


Monthly Archives: July 2008

Beverly Hills Plastic Surgeon on The View

Yesterday, July 24, 2008, I had the opportunity and privilege to appear on The View in New York. This was a fascinating and wonderful experience, speaking with the hosts, including Whoopi Goldberg.

The segment was on plastic surgery and included multiple subjects associated with husband and wife plastic surgery, teenage plastic surgery and You-Tube plastic surgery.

I spoke specifically about You-Tube videos and plastic surgery because I felt it was important to explain the three reasons why I post videos from television on You-Tube. These included:

1) Education – educating patients on You-Tube with videos from shows such as The Discovery Channel, Woman’s Entertainment and The Learning Channel, as well as Entertainment Tonight and Extra, in order to help safeguard patients from unqualified plastic surgeons, as well as procedures with risks and complications.

2) Entertainment – You-Tube videos should be entertaining and not boring, otherwise, nobody in the public is really going to enjoy watching it; and lastly,

3) Marketing – marketing on You-Tube and the internet, is obviously a very important method of increasing volume in your practice, allowing exposure.

Once again, it has been a privilege and an honor to appear on The View in New York on July 24, 2008. This is certainly an experience that I will remember.

BREAST IMPLANTS When Bigger Isnt Always Better

When Dr. Linder performs breast augmentations in Beverly Hills, his number one goal is to proportionalize the woman’s body in order to allow for the perfect shape and figure.

Bigger isn’t always better with breast augmentation

Patients often ask to go to very large size breast implants into a very full D to DD size. We feel that going this large can be very detrimental to the patient’s final outcome. Bigger isn’t always better with breast augmentation, especially when the implants are too large. Saline and silicone breast implants can reach up to 800 cc and can even be overfilled larger than that with saline implants. Problems with large saline and or silicone implants can include increased risk of rippling and visibility along the sides. The larger the bag, the greater the folding of the bag along the side, especially along the lateral breast area with visibility and palpability of the implants being obvious.

Problems with over sized breast implants

Celebrities like Pamela Anderson have had multiple breast surgeries, which can lead to increased skin laxity. Enormous implants in celebrities can also increase stretching of the skin, which can lead to requirement of breast lifts which can obviously create significant scarring. It can also thin the tissue to a point where revising this breast can be very difficult and or dangerous with skin loss and problems with blood supply to the nipple areolar complex.

Overly enlarged implants can also increase the risk of stretch marks, especially during a virgin or a primary augmentation. When performing the original surgery, if an enormous breast implant is placed subpectorally in a woman with very tight tissue that hasn’t softened over time, this can increase the risk of stretch marks which is cracking of the skin and scarring around the areola and expanding outward like sun rays from the sun. Furthermore, overly-enlarged breast implants can increase the risk of scar tissue contracture and increase capsulation which can thin out the tissue and once again make it more difficult to revise the breast.

When overly-enlarged implants are placed, the stretching of the tissue can be significant and if a smaller implant is desired years later, it may require a formal mastopexy using the Wise-pattern or the anchor scar in order to reduce the massive amounts of increased skin due to the stretching effect. Therefore, consideration should be made when placing implants at any time.

Proportionality is the key

Proportionality is the key in allowing the implant to allow the woman’s figure to be made more beautiful without expanding to such a large size where she becomes disproportionately large which increases risk of complications.

When Dr. Linder performs breast augmentations on celebrities, movie stars and swimsuit models, he is very adamant about obviously not going too large. We do not want to type cast the woman out of roles for her future. We also don’t want to make a woman too disproportionately large, which in Hollywood is actually not favored.

Stuart A. Linder, M.D.

Scarless Breast Augmentation

Breast augmentation can be performed through many different methods, including periareolar (under the nipple), transaxillary (through the armpit), inframammary (under the breast crease) or transumbilical (through the umbilicus).

“The Scarless Breast Augmentation, is it worth it?”

The scarless breast augmentation would be considered a procedure where there is no incision on the breast such as a transumbilical. The problem with transumbilical augmentation is although good results may be obtainable, there is a much higher rate of malposition of the implant, with the implant being placed in the improper position.

If you think in common sense, going from the umbilicus or belly button all the way up to the submuscular breast area is a very long way to track predictability of placing the implant perfectly is very difficult, even in the best hands. Think in a synonymous manner, such as in the world of golf. It is much easier for Tiger Woods to hit a 2 foot putt than it is to hit a 25 foot putt. In other words, placing an implant under the nipple allows you to probably release the muscle directly upon the muscle rather than trying to release the muscle through the belly button is a very long, long track or a long putt, even for the best of hands.

Problems with Scarless Breast Augmentation

The problem with transumbilical augmentation (scarless breast augmentation) is that there is a significant chance that the implants will be placed too far or too high, which means the patient may have superior retropositioning of the implant with the implants too high and the parasternal attachments of the muscle may not be released properly as well as along the parasternal area which may lead to poor sternal cleavage.

Implant positioning is absolutely essential in breast augmentation surgery. When we perform and place over 1000 breast implants annually, positioning the implant in the proper position time after time after time is absolutely essential.

Therefore, by going through the inferior areola, the scars first of all heal quite nicely in the majority of patients. Second, I can very easily safely and predictably release the pectoralis muscle and produce a pocket that is precise. Also, dissection of tissue lateral to the areola can be performed very precisely and thereby the implant vector force can be towards the middle of the chest which would increase and give a more beautiful cleavage rather than an unpredictable release of tissue laterally, which will cause the breast implants to be too far to the side, something that our patients absolutely despise.

Therefore, when considering breast augmentation and the so-called scarless technique of transumbilical, think in your mind what your final goal is. Is it more important to have a predictable result with the implants placed properly thereby lining up the inframammary fold, the nipple and enhancing cleavage, or is it more important to have no scar whatsoever on the chest and have the implants placed in a possibly more unpredictable and haphazard manner.

Stuart A. Linder, M.D.