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Dr. Linder's Blog

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Monthly Archives: May 2009

Favorable Approach to Breast Augmentation

Dr. Linder sees patients from all over the world, especially Beverly Hills as well as Las Vegas.  He now is licensed in both states, California and Nevada.

breast_aug30 My favorite approach to breast augmentation is through the periareolar (underneath the areola).  Through a very small incision, an implant can be placed under the muscle using the dual plane technique, safely and predictably with reduced incidents, in my opinion, to nerve injury, breast duct damage, allowing patients to have sensitivity as well as have reduced loss of lactation.

Placement of implants through the periareolar approach is safe and predictable and allows for good cleavage and evenness of the inframammary folds.  I do not favor the transumbilical approach, as the distance is so far from the umbilicus to the pocket of the chest wall that it is, I believe, more difficult to position the implant perfectly and I believe that malposition is much higher, as well as releasing of the muscle is much more difficult to do.  Through the periareolar approach, the release of the parasternal and the inframammary attachments of the pectoralis major muscle is only about 2 to 2.5 cm.  From the transumbilical it is obviously well over 20 to 24 cm, which is such a long distance that I believe a meticulous dissection is very difficult, if not completely impossible.

In any case, I also do not like the transaxillary approach in that the implants have a higher rate of malposition, double-bubble deformity which once again the parasternal release of the muscle is not perfectly done and therefore the implant then goes too high.

NEW LAS VEGAS OFFICE OPEN

Dr. Stuart Linder is a Board Certified Plastic Reconstructive Surgeon and member of the American Society of Plastic Surgeons, and is thrilled to be seeing patients in his new Las Vegas office starting May 2, 2009. Because Dr. Linder specializes in breast augmentation and breast revision surgery, we believe that there are many women to see and consult with in the Nevada area.

LAS VEGAS ADDRESS

Revage Medi Spa
1225 South Fort Apache Road, Suite 145
Las Vegas, Nevada 89117

He will available for consultations on an every other Saturday basis by scheduled appointment only.

Upcoming excite events include book signings at Borders Book Store in Summerland, Nevada on May 23, 2009 from 2:00 p.m. to 4:00 p.m. Dr. Linder will also be appearing on Fox News in the near future to discuss breast revision surgery.

He is excited to bring his talent on body sculpting with an emphasis on revision of breast implants, including open capsulectomy, removal and replacement, explantation, repair of double-bubble deformity, bottoming out and significant asymmetries to Las Vegas, Nevada.

SUMMARY OF SCARRING RELATED TO BREAST REVISION, BREAST LIFT AND BREAST REDUCTION SURGERY

In general, patients who undergo formal mastopexies or the inferior pedicle Wise-pattern scar or breast reduction using the similar approach will have scarring which can never be completely predictable.  Realize that scarring can be associated with hypertrophic, keloid, widespread, hypo or hyperpigmentation.  We inform patients both in verbal as well as written consents of the unpredictable nature of scarring in that there can never be a final guarantee as to the final appearance of the scar.  As a result, patients should understand that scarring is an enormous component of breast reduction, breast lift and abdominoplasty surgery and if the patient isn’t completely accepting and realistic as to final possible outcomes of scarring, she or he should not undergo the operation that would require these incisions to remove lax or loose redundant skin. 

Please refer to www.breastrevisionsurgeon.com for further information on scarring.

BREAST AUGMENTATION AFTER BREAST REDUCTION SURGERY

Patients who present to me for revision breast reduction surgery have often already undergone breast reductions, through the years have had weight fluctuation, often weight loss and/or involutional atrophy of the breasts associated with pregnancy or breast feeding.  They now present for breast augmentation to regain fullness and reduce the involutional upper pole atrophy of their breasts. 

Today, May 20, 2009, I will be performing two of these operations, enhancing women’s breasts who have already undergone breast reductions who have minimal breast tissue.  One will undergo saline augmentation using high profile implants behind the muscle and the second will undergo silicone gel implants in a similar pocket due to the minimal amount of breast tissue which could lead to increased visibility and rippling, especially along the lateral breast areas.  These patients will also undergo revision breast lifting by tightening the lateral inframammary fold in order to reduce the boxiness shape of the breast and regain a round and more narrowed breast appearance. 

Breast implants should be placed behind the muscle whenever possible in patients who have undergone reduction mammoplasty procedures in order to reduce visibility, palpability and increased risk of capsular contracture. 

It is important, in my opinion, to not go too large with your implants to reduce upper pole fullness as this could lead to round, fake and an unnatural appearance.

BREAST ASYMMETRY AFTER BREAST AUGMENTATION

breast_asymmetry17a Patients present with breast asymmetry prior to undergoing their implant surgery.  That’s why in reality it’s difficult, if not impossible, to completely correct asymmetries. However, asymmetries must be identified in the early stage prior to surgery in order to allow for volume changes.

When a patient has already undergone breast augmentation with saline or silicone and will undergo breast revision surgery to correct this problem that wasn’t corrected initially, several approaches can be taken.  Breast revision surgery for secondary breast asymmetry problems include:
1. With saline implants refilling or reducing volume of one implant.
2. Replacing the saline implant altogether presenting a larger saline implant.
3. With silicone implant replacing with a larger or smaller silicone implant to the asymmetric side.
Patients who present to Dr. Linder in both Beverly Hills as well as in his Las Vegas practice, present with breast asymmetry preoperatively.  These patients’ folds are marked.  The distance of the inframammary folds must be identified and the distance between the inferior areolar to the inframammary fold distance shall also be reviewed.  Patients should be asked and clinically examined for obvious asymmetry in a brassiere.  When it is identifiable significant and saline implants are to be used before original surgery has occurred, then a different size implant of different volume will usually be used.  If the asymmetry is only slight, then the same implant volume, however, titrated differently.  For example, a 400 cc filled to 400 cc and a 400 cc filled to 430 cc can be placed in order to regain symmetry.  With silicone patients this is more difficult in that silicone implants will require obviously a standard pre-filled implant which cannot be changed in the operating room in terms of titrated volume.  The smaller volume of silicone implants has shorter ranges.  For example, 25 cc differences which can allow for increased symmetry.  As you get into the 500’s and larger, the volumes up by 50 cc make it more difficult to titrate the symmetry volumes.
When a patient presents with asymmetry after original breast augmentation and has saline implants, we like to obtain the previous operative report and implant catalog lot number and serial number with implant volumes identifiable.  Frequently, patients do not have access to the records and therefore Dr. Linder in the operating room has to make his own judgement through his experience of thousands of breast surgeries and revisions to determine the proper size and most appropriate volume.  Most importantly, remember that breast asymmetry, both before the original breast augmentation as well as after the primary augmentation is the norma and regaining absolute perfect symmetry is difficult, if not completely impossible.

Breast Revision and Fox News Las Vegas

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Dr. Linder is pleased to be filming on Fox News Las Vegas on 05/07/2009.

The first two episodes will be associated with:

1) Las Vegas Breast Revision Surgery, which will emphasize which patients are candidates for breast revision surgery, the type of procedures that we perform, what a woman should do when she has a ruptured implant, how to diagnose breast implant problems, and which doctors are qualified to perform breast revision surgery.

2) The second segment on Fox News Las Vegas, that will be airing, will include the topic of Breast Augmentation, Silicone versus Saline.  Some of the questions answered include differences between the two implants, which patients are better candidates for silicone versus saline, what are the pitfalls of saline implants versus silicone gel implants, what are the cost differences between silicone and saline implants, and finally what are the most important diagnostic tests that are used to perform imaging of breasts, silicone with MRI and saline with mammograms.

Dr. Linder is pleased to be in Las Vegas as a Licensed Board Certified Plastic and Reconstructive Surgeon who specializes in breast augmentation and breast revision surgery in Beverly Hills, Hollywood and Las Vegas.

What to do for a Ruptured Breast Implant

breast_revision98 Patients present to me for breast revision surgery weekly from all over the country. They are concerned that obviously a breast implant has ruptured. This is obviously much more noticeable with a saline than a silicone implant.

Saline implant ruptures can either be slow or quickly and usually over a several week period the breast will become quite diminished in size and significantly smaller than the contralateral side. As soon as you determine that you have a ruptured implant and it is obvious to the visual eye, you should seek a Board Certified Plastic and Reconstructive Surgeon immediately to have surgical correction of this problem.

In Dr. Linder’s Beverly Hills and Las Vegas practice, patients who present with this discuss the options. The first and most impressive option is to go to surgery in the next few days in order to have the implant removed and pocket irrigated as soon as possible to prevent scar tissue contracture of the pocket and the pocket from walling itself off. The longer you wait with a ruptured implant, the more encapsulation scar tissue and the greater the risk of a Baker IV capsular contracture. The tendency of the body is to fill in space either with fluid or to tighten through scar tissue contracture. When an implant deflates, the spacer or the implant is a natural size is now obviously reduced and diminished and there is encroachment, entrapment and compete collapse of the pocket. Usually, the collapse is from superior to inferior and the pocket closes superiorly to inferiorly causing even inferior displacement of the implant which could lead to severe bottoming out, which can lead to other problems and severe breast deformity.

Silicone implant ruptures are more difficult to detect. If a patient has trauma such as blunt trauma from a motor vehicle accident and a whiplash from seatbelt, an MRI should be done immediately to detect rupture of the implant to determine if there is a positive linguini sign significant with a tear within the implant shell. A ruptured silicone implant should also be immediately repaired by simply explantation, open capsulotomy and replacement with a new silicone gel implant.

The quicker you address the problem of a ruptured implant, the less the trauma, damage, encapsulation and scar tissue can form around the bag causing more difficulty in recreating a normal shape.

Dr. Linder looks forward to seeing patients every day who require breast revision surgery in Las Vegas,  Beverly Hills, Hollywood and throughout the world.

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