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Monthly Archives: March 2009

Plastic Surgery for a Mother and Daughter

Very rarely as a Plastic Surgeon do you have a day like I did a few weeks ago where I had the privilege to perform surgery for two members of the same family.
I thought I would share their testimonials:

March, 2009

“Dr. Linder

I want to thank you for your professionalism and the great attention you and your staff showed me from day one.
I am so happy with the outcome of my surgery. I am 52yrs old and now feel like a new woman. My breasts are back in position and my tummy is flat as a board. My confidence is over the roof and I see the twinkle in my husband’s eye. We both can’t wait for our get away vacation to show your work off. I am truly grateful and thank you again from the bottom of my heart.”

E.A. (Mother)

“Dr. Linder and Staff

First, I want to start by telling you and your staff, thank you very much for my new look. If it wasn’t for you, Dr. Linder, I would’t be looking this good. My breasts were deformed and hard, but due to your unbelievable talent they now look awesome!

Thank you so much, you are truly an artist.”

J.A. (Daughter)

Breast Implant Sizes to Consider, 125cc to 850cc

In general, breast implants vary in size and volume. As a result, this will obviously create the size of the breast.

breast_aug26There are three different style saline and three different style silicone implants with McGhan, Natrelle implants manufactured in 2009. The three styles of saline includes a style 68 low profile, also referred to as the moderate profile, which ranges anywhere from 125 cc to 680 cc implant fill. Style 68 moderate profiles, which are now the moderate plus, range from `120 cc all the way to 800 cc. Finally, the style 68 high profile smooth round implants, which are the ones Dr. Linder favors, range from 160 cc all the way up to 800 cc. These implants can be filled approximately 10% of its original volume. An 800 cc implant can be filled, according to Allergan, to approximately 850 cc.

breast_aug38The Natrelle silicone gel-filled implants that are smooth and round, include Style 10, Style 15 and Style 20. The Style 10 moderate profiles, which are the low profiles, range in volume set from 120 up to 800 cc. I believe these are very flat, very wide and they give women a matronly flat appearance and heavy upper chest area with loss of upper pole fullness. I do not prefer these implants in the majority of our patients. The Style 15 is the mid-range moderate plus silicone gel. These can be useful in certain patients who just do not want any upper pole fullness whatsoever and want a little bit more narrow implant than the moderate Style 10.

Dr. Linder favors the Style 20 high profile smooth gels because these are the narrowest, most tapered implants. They range from 120 cc silicone gels up to 800 cc. Dr. Linder enjoys using high profile saline and silicone implants every week because they give great projection and they are not too wide, which is what he believes women want. They want to look thin, not fat and matronly, which can be seen with the flat moderate profile implants.

Breast Implant Surface, Smooth or Textured

Beverly Hills breast augmentation specialist, Dr. Linder, prefers smooth breast implants. Textured breast implants have been the mainstay of implants back in the 60’s, 70’s and 80’s. Textured implants have been shown to reduce capsular contracture scar tissue formation when implants are placed above the muscle subglandular or retromammary.

breast_aug12However, textured implants are no longer in vogue. In fact, textured breast implants have a higher rate of rupture and crack over time. What happens is the textured coating of the implant will fibrously adhere to the breast tissue and just like a credit card that you twist over and over, will crack over time. Smooth breast implants obviously cannot adhere to the tissue in a Velcro-like fashion and therefore smooth implants don’t normally crack along the implant edges.

breast_aug0001Textured implants also can cause increased visibility and rippling, especially when placed above the muscle. These implants stick to the tissue like Velcro, fibrously adhere, and therefore grow into the tissue and form ripples and visibility, especially along the lateral breast. As a result, textured implants in Dr. Linder’s practice are no longer used, only smooth saline and smooth silicone high profile gels are his preference. Smooth implants under the muscle do not have a significant increase capsular rate than textured. However, smooth implants again do not adhere and do not have the same problems that the textured implants have with failure, cracking, rupture, as well as malposition.

Textured implants often can cause double-bubble deformities or implant malposition because the implants may stick in an improper position. This can be seen with the anatomical style 468, previously used McGhan style 468 implants that Dr. Linder used 10 years ago. He no longer favors these implants because once again, rotational deformity can occur with the textured implants, with especially an anatomical and these implants can then stick in the wrong position and have an absolutely bizarre shape and disfigurement to the breast.

Smooth breast implant surfaces are preferred in the year 2009 in all of Dr. Linder’s Beverly Hills breast augmentation patients.

DOES BREAST SIZE AND SHAPE REALLY MATTER?

Most people are aware that breast implants come in many different sizes. What you may not know, is that they also come in a variety of shapes.

For example; there are anatomical (tear drop) shaped implants, there are round implants, which come in high and moderate-profile and are available smooth or textured, and then there are reconstructive implants, which have a much broader base (increased widths).

I prefer to use round implants for my patients choosing to undergo elective, cosmetic breast augmentation. Shaped implants can rotate, which can lead to a deformed appearance of the breast. If this occurs, it can only be corrected by the patient undergoing an additional surgical procedure.

In the debate between high-profile vs. moderate-profile saline implants: Which shape you choose will greatly impact your result. I prefer high profile McGhan/Mentor saline implants because the results give a greater projection (anterior-posterior) with a narrower diameter. This gives the patient a fuller breast with a tapered, less matronly appearance. In my practice, I have found throughout the years that the majority of women desire this fuller, more natural appearance and that they like the cleavage that the high-profile implants give them. Moderate profile implants do not provide the same effect.

Which implant you choose depends on the look that you want to achieve. You and your Board Certified Plastic Surgeon should go over all of your options and pick the one that works best for you.

Just remember, when you ask yourself the very important question,

Does Shape Matter?

The answer is most definitely a resounding Yes!

Patient's Choice Award 2008 Given to Dr. Linder

Patients Choice Award 2008According to American Registry, Dr. Linder has been selected for the Patient’s Choice Award for 2008.

He has been elected as a member of this elite group by more than 400,000 patient reviews and ratings that have been gathered and this top rating was awarded only to a select few physicians, doctors and plastic surgeons.

Dr. Linder is a Board Certified Plastic and Reconstructive Surgeon whose number one concern is a safe and predictable result for each and every one of his patients. Dr. Linder takes the time during consultation in the operating room and postoperatively to make every effort possible to achieve the best result possible for each patient.

Once again, Dr. Linder is thankful to American Registry and Vitals.com for selecting him and recognizing him with the Patient’s Choice Award for 2008.

Beverly Hills Breast Asymmetry, What To Do

Dr. Linder specializes in breast augmentation and breast revision surgery. Patients present with breast asymmetry almost weekly. Fixing breast asymmetry can be tricky and does require skill, experience and judgment as can be found with most Board Certified Plastic and Reconstructive Surgeons.

breast_asymmetry17aBreast asymmetry can be congenital which often presents with a larger saggy breast on one side and a smaller, more conical or tubular shape breast on the other side with poor or arrested development. To repair these, usually the smaller breast only requires an implant as long as the nipple is above the inframammary fold. The larger breast which is saggy, will require a smaller implant obviously, as well as a breast lift.

The breast lift normally will either be a vertical or a formal mastopexy using an inferior pedicle Wise-pattern or an anchor scar. Implants of different sizes can be used. In general, we prefer to use saline implants with significant breast asymmetries because we can titrate the volume of the implants which can lead us to more precision, accuracy and final breast volume.

breast_asymmetry18aSilicone gel implants, however, can be used if the asymmetry is slight and not too significant. Breast asymmetries are seen in most women, at least slight asymmetry, however, when they become significant, they can be physically and psychologically tormenting to the woman’s self-esteem. Repairing asymmetries, once again, usually requires placing the implant, either saline or silicone, in a dual plane (half under and half over the muscle or two-thirds under, one-third over depending upon the thickness of the muscle), as well as reconstruction and removal of skin on the saggy breast side, which can be performed by simply removing skin around the areola and along the vertical plane and along the inframammary fold. To completely correct breast asymmetry, the absolutely correct breast lift must be performed. When a patient has grade 3 ptosis and the nipple is well over 3 cm below the inframammary fold, a formal mastopexy is usually required and that is an anchor scar.

When patient have a conical or tubular breast on one side, this can be easily enhanced with a larger saline or silicone implant and release of the tubular inferior pole of the breast with radial striations of the lower pole above the pectoralis major fascia is performed in order to round out the lower pole of her breast.

Dr. Linder enjoys fixing breasts from patients throughout the world and right here in Beverly Hills. Breast asymmetry is a challenging operation. Only Board Certified Plastic Surgeons should be performing these operations. They have the experience and judgment to allow for a reasonable and favorable result.

SPECIAL AWARDS FOR BEVERLY HILLS BREAST IMPLANTS FROM ALLERGAN AND MENTOR CORPORATION-2009

Dr. Linder is honored to receive the Allergan Partner Privileges Award which recognizes our ongoing commitment to Allergan’s Premier Portfolio in use of silicone and saline breast implants. This was awarded on September 14, 2009 by Allergan Pharmaceutical who has created Natrelle gel implants, saline implants aka McGhan Corporation.

BHAllerganMentor1

Mentor Corporation has also awarded Dr. Linder the Memory Gel Post-Approval Study Award for his commitment to research in the field of Plastic Surgery with the use of silicone gel Memory implants. Dr. Linder is always pleased to use the two FDA – approved silicone implants by both Allergan Pharmaceuticals and Mentor Corporation in his practice on a weekly basis.

BHAllerganMentor2

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