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Dr. Linder's Blog

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Monthly Archives: December 2008

Fold Breast Revision in Beverly Hills and Hollywood

As an expert in the field of breast revision surgery, it is essential that the inframammary fold or the fold of the breast be corrected if it has been malpositioned from previous surgeons.

The inframammary fold is where the pectoralis fascia interdigitates underneath the breasts to the subdermic and creates a fold, which is the under-hanging that you feel underneath the breast. Normal distance is between 5 and 7 cm from the 6 o’clock position of the inferior areolar to this inframammary fold. Standard is approximately 5.0 cm. It is absolutely vital that the fold be maintained during breast augmentation surgery.

Malposition of the inframammary fold occurs all the time with surgeons who are inexperienced or have poor judgment. Placing implants through the bellybutton or umbilicus or transaxillary, although in some hands good results can be obtained but many results are horrific. In fact, the inframammary fold through the transaxillary approach can be released too much causing severe bottoming out of the implants in which the nipple is superiorly retropositioned, in other words, on top of the upper pole of the breast, while the remainder of breast tissue has descended with gravity and the fold has been lowered in an unnatural fashion. This is extremely difficult to fix. Ways of repairing it include inframammary skin lifts and formal mastopexies and an internal capsulorraphy, where the fold is tightened internally. The internal capsulorraphy does not always work and these sutures can rip out or the folds can look strange and not round in appearance

Fixing lowered inframammary folds from bottoming out are much more difficult than when inframammary folds are high. When they are high and you have double-bubble deformity or malpositioning of the implants with the implants too high, the folds can be released by releasing the capsule, performing an open capsulotomy through a direct periareolar approach.

So, the fold in breast revision surgery is one of the most vital landmarks on the breasts and Board Certified Plastic Surgeons have the experience and judgment to make sure the inframammary fold is positioned correctly in the operating room and during revision surgery it is corrected so that the breast once again has a normal natural appearance and the nipple areolar complex will be placed centrally.

High Riding Breast Implants

High riding implants occur when the inframammary fold is not released accurately or adequately. This can often occur with transaxillary augmentation where the implants are placed through the armpit and the implants are not allowed to fall and descend to the normal natural inframammary fold. Women, who are very small preoperatively, have hypoplastic breasts, ectomorphic build and have minimal breast tissue, may have a poor ill-defined inframammary fold. As a result, the transaxillary approach or transumbilical approach may lead to the fold not being released correctly or lowered to the correct position, which may allow the implant to sit too high on the woman’s chest.

Because Dr. Linder is a world renowned breast revision specialist and breast revision surgeon, it is his job to release the inframammary fold correctly on a virgin augmentation as well as to repair it on patients who need revision surgery. Often, Dr. Linder sees patients with implants that are too high, that simply do not have the release of the parasternal and the lateral attachments of the pec major muscle. The muscle acts as a catcher’s mitt, elevating the implant and causing a very unnatural appearance to the chest. When considering high riding implant revision, only go to Board Certified Plastic Surgeons who have the experience to fix this problem.

Full Face Transplant

Recently, at the Cleveland Clinic in Ohio, a woman underwent an amazing near total face transplant, which included 80% of her face, using donated female cadaveric tissue in a 22-hour surgery. This is considered the first face transplant in the United States of America and four have been performed throughout the world in the past.

The transplant included bones, skin, muscle, nose and blood vessels.  She received a reconstructed total nose, including sinuses, the upper jaw and dentition.  The patient had had multiple surgeries; however, still had a horribly disfigured face and as a result the near total facial transplant was their only hope.

The tissue was given to her as a gift through the General Organ Donation Banc, according to Life Banc, which is Oregon procurement group in Northeast, Ohio.  This was an extraordinarily risk operation realizing that the patient could end up with severe complications and must be immunosuppressant drugs the rest of her life in order to prevent her own body from rejecting the donated parts.

The patient, according to the Cleveland Clinic surgeons, is doing quite well.  Her name and photographs have not been release at this time.

Dr. Stuart A. Linder

Breast Reduction Specialist Beverly Hills

Dr. Linder recently has placed his new Breast Reduction Specialist website in order women to gain all the information necessary when considering breast reduction surgery. Statistics by the American Society of Plastic Surgeons and the American Board of Plastic Surgery state that the breast reduction procedure patients seem to be the most satisfied patients of any procedure performed by Board Certified Plastic Surgeons. And it’s no wonder why. These women who have had massive breast hypertrophy, gigantomastic breasts, have symptoms including back pain, neck strain, grooving from their brassieres, rashes underneath the breasts and their functional symptoms can be completely obliterated by the reduction mammoplasty procedure. Removing a significant amount of breast tissue will not only lift the breasts, but also remove all the functional heaviness that causes the back pain, neck strain and the grooving of the shoulder blades associated with the brassiere.

Dr. Linder performs breast reduction surgeries every week in his ambulatory center in Beverly Hills. The breast reduction procedure is one of his favorite operations. It requires skill, experience and good judgment to do the surgery correctly. In order to maintain blood supply of the nipple areolar complex, the pedicle must be kept intact. This is a portion of tissue that remains down to the fascia of the muscle and this will allow for the nipple areolar complex to remain viable. Only Board Certified Plastic Surgeons should ever perform a breast reduction operation. Under no substitute should any other surgeon do this operation due to the skill and experience required.

Once again, please visit his new Breast Reduction Specialist website in order to review procedures, risks, complications, photographs, as well as television shows, including Discovery Channel and The Learning Channel on which Dr. Linder performs the breast reduction procedure.

Beverly Hills Plastic Surgeon featured on The Pink Channel

So far, we have done multiple episodes on the XM Radio Channel 24.  Working with the Pink Channel has been fantastic.  Discussing issues in plastic and reconstructive surgery to educate women is an honor and a true privilege.  We have done episodes which have included Breast Reduction, Silicone versus Saline Implants, the Meaning of Plastic Surgery, What not to Inject in your Face and other issues concerning body sculpting procedures.

The segments can be heard throughout the day and throughout the United States on XM Radio, Channel 24, interspersed between fantastic music from the 70s, 80s, and 90s.  I look forward to our continued relationship, working on the XM Radio, Channel 24, The Pink Channel with its association with the City of Hope for Breast Cancer Reconstruction.

Awful Hollywood Plastic Surgery

Why do so many celebrities look so poorly after their plastic surgery procedures? This can be separated from facial versus body sculpting.

Many patients who undergo body sculpting surgery procedures who are celebrities unfortunately go to doctors who are not Board Certified in Plastic Surgery.

It is absolutely essential that the doctor be a Diplomate of the American Board of Plastic Surgery, Fellow of the American College of Surgeons and a member of the American Society of Plastic and Reconstructive Surgeons. These are the diplomates who have the experience and judgment to allow patients to get the best results with the lowest rate of complications. All surgeries have risks and complications stemming from bleeding, infection, scar tissue, etc. However, these incidents can be reduced greatly by going to qualified Board Certified Plastic Surgeons.

Celebrities who have awful facial surgery often include patients who have lips that are too enlarged. Sometimes prosthetic or silicone injections are done into the lips which cannot be reversed. This can be, in other words, irreversible and horrifying and unable to repair. Some patients have chin implants or cheek implants that are way too large for their face and are disproportionate to the anatomy of the woman or male face and completely changes the aesthetic look whatsoever. Sometimes it is difficult to even recognize certain celebrities. We will not discuss specific celebrities out of complete respect.

In body sculpting procedures some of these patients undergo breast augmentation implants that are way too large for their bodies which can type cast them completely out of Hollywood. Liposuctioning can be performed by unqualified surgeons, over-aggressively, which can lead to botched abdominal areas with skin hanging everywhere and lumpy irregular contour deformities.

When considering any form of plastic surgery, whether facial or body work, it should be done in a natural manner and the results should be elegant and beautiful and not disproportionate or bizarre and this can be done by making sure you see hundreds, if not thousands, of before and after photographs by your Board Certified Plastic Surgeon before undergoing the surgical procedure that you want.

Remember, unlike returning a purse or a pair of expensive shoes, if your face and/or body is mutilated, it may be irreparable.

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