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Monthly Archives: January 2009

Ruptured Breast Implants

breast_rev24Patients present to us in Beverly Hills / Hollywood for ruptured breast implants every week. Ruptured implants can occur for many reasons. They can occur due to trauma, blunt trauma, such as a seatbelt whiplash accident or even being assaulted. It can also occur simply due to wear and tear of an implant.

Smooth versus textured implants have different rates of rupture. The textured implants have a significantly higher rate of rupture because they develop fold creases within the shell, which will adhere to the tissue surrounding it and the capsule and with time will crack and leak. As a result, we prefer not to use textured implants any longer. Smooth implants can rupture as well. Rupturing can occur anywhere within the implant bag, the valve can leak or a small pinpoint rupture can occur along the circumferential periphery of the implant edge.

In any case, what do you do when you have determined that you have a ruptured implant? Saline implant ruptures are clinically obvious. The implant will completely deflate and the breast will look completely smaller and asymmetric from the other side. This should be taken care of as soon as possible because as the implant continues to deflate, scar tissue will trap and reduce the volume size of the pocket, causing collapse of the pocket. An open capsulotomy versus possible capsulectomy with implant removal and replacement should be done as soon as possible under general anesthesia. Only Board Certified Plastic Surgeons should do these operations in a Medicare and State Licensed Facility with a Board Certified Anesthesiologist, under general anesthesia.

Silicone ruptures can be silent in that they may not even be noticeable for many years and that the breast size may not reduce in size at all. MRI’s should be done whenever there is thought of a rupture or every two to three years per FDA requirements as of November 2006. Just as with saline, silicone implant ruptures should be immediately addressed. Now, silicone implant ruptures can lead to calcifications, silicone granulomas and silicone gel leakage to the axilla or other lymph nodes within the body and therefore should be immediately addressed surgically.

Please see our breast revision website  for other information on ruptured implants or other problems with implants postoperatively.

Dr. Linder Featured in Cosmopolitan Magazine

Dr. Linder Contributing Author, Writer for Cosmopolitan Magazine
February 2009

If you pick up next month’s issue of Cosmopolitan, now available in book stands and book stores throughout the country, you’ll find a very interesting article on 25 wacky questions about plastic surgery.  Both Dr. Stuart Linder and Dr. Robert Kotler were given the opportunity to help write this article.  The article has interesting questions about body sculpting and facial plastic surgery.  Dr. Linder specifically addressed issues on breast augmentation and lipo sculpturing of the body.

Pick up a copy of Cosmopolitan 2009 and review the interesting questions and answers.  This can also be found on www.drlinder.com under the Media section, as well as under the Book section, as Dr. Linder’s Book, The Beverly Hills Shape is mentioned as well in the article.

Inverted Nipples, Beverly Hills Plastic Surgery

Inverted nipples are not an infrequent problem that we see in our Beverly Hills practice.  Patients can present with a variety of different degrees of inversion of the nipples.

Usually, the nipples have suspensory ligaments that help to maintain them in an outward position.  If these ligaments are short, the nipples may invert and it may be very difficult to correct this problem.  Attempts to correct the inverted nipples are often very difficult and frequently unsuccessful.

Pursestring sutures may be placed after making an incision around the base of the nipple in order to pull the nipple up.  Unfortunately, this does not always work.  I have found that in mild to moderate cases of inverted nipples with patients having augmentation mammoplasty procedures, the compression and pressure of the implant anteriorly causes the nipples to sometimes evert nicely, at least to 50 to 70 percent, better than the original positioning.

We never guarantee a patient, however, that the breast implants will correct the problem completely.  Surprisingly, however, we have had good success with moderate nipple inversions with the implants placed subpectorally, causing the compression and eversion of the nipples.

I personally have found that pursestringing the nipples on the base can be difficult and recurrence is frequent.

Breast Augmentation Above versus Below the Muscle

Breast implants can be placed either above or below the muscle or placed within the dual plane, which means two-thirds under and the lateral one-third over.

At my Beverly Hills breast augmentation practice, we prefer to place the implants behind the muscle whenever possible because it helps to reduce scar tissue, capsular contracture as well as constantly reduce risk of rupture of the implants.

Placing the implants behind the muscle is important because of the pectoralis major muscle acts to lubricate the implant and it helps to reduce scar tissue formation around the bag. This has been shown throughout several decades of studies. The implants should be placed either subpectoral or using the dual plane technique with two-thirds placed under the muscle along the parasternal ridge, along the infraclavicular and out towards the lateral pectoralis minor muscle.

Implants that are placed above the muscle look more unnatural. They also are rounder in shape in the upper pole and often appear to look fake. Implants placed behind the muscle have a more natural shape, hold better, and have less sagginess and less degree of ptosis as time goes on. The muscle acts to keep the implant up, acts as a sling and reduces sagginess to the breast.

In 2009, most saline and silicone implants should be placed behind the muscle or subpectorally in order to maintain its shape over time and create a more natural appearance and reduce the capsular contracture or scar tissue formation.

Please visit www.drlinder.com or www.breastrevisionsurgeon.com which shows severe cases of implants with encapsulation where the implants have been placed above the muscle, which has led to increased scar formation and a disfigurement of the breasts.

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