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Dr. Linder's Blog


Monthly Archives: September 2009


Gynecomastia is a procedure that Dr. Linder enjoys the challenge of performing.  Male gynecomastia is associated with increased defeminized tissue usually found retro to the areolar complex as well as fatty tissue that may be increased in volume from the infraclavicular, parasternal, inframammary fold to the anterior axillary line in men.gyno_front_

It can be associated with the use of steroids, marijuana and other medications.

Gynecomastic surgery can be performed in several variances.  The mild forms of gynecomastia may only require tumescent liposuction technique, liposuctioning the chest area.

In moderate cases, which we normally see, Dr. Linder performs both a periareolar incision with a retro-periareolar excision of a wafer of glandular tissue removed from behind the nipple areolar complex as well as liposuctioning of the chest area from the anterior axillary line along the lateral pectoralis major muscles from the infraclavicular and along the sternal region.gyno_side

This combination of liposuction and direct excision of partial subcutaneous mastectomy have led to excellent results for gynecomastic surgery.

Very severe forms of gynecomastia with severe skin laxity may require a form of mastopexy which actually requires scars as similarly seen on women that have breast lift procedures.  (Please see the above example of gynecomastic surgery where tissue has been removed from behind the nipple areolar complex both through direct excision as well as liposuctioning of the chest.)


Capsular contracture is one of the most common problems associated with all women having breast augmentation.  We see this every day in our Beverly Hills practice.  Dr. Linder specializes in breast revision surgery.  Capsulectomies and capsulotomies are a large proportion of his operations.  Capsulectomies are removal of scar tissue and the capsulotomy is the circumferential open release of the scar tissue without removal of the tissue itself.breast_rev30

There are four Baker classifications of scar tissue.  Baker I is minimal or none, Baker II is palpable, Baker III is palpable and visible and Baker IV is palpable, visible and painful, hard and cold breasts.  Baker IV contractures are associated with sometimes severe pain with distortion and deformity of the breasts.  Often, there is superior retroposition of the implant with often even a double-bubble deformity.  These operations require skill and experience from Board Certified Plastic and Reconstructive Surgeons.

A capsulectomy is performed to remove scar tissue when patients have enough coverage that it will not increase visibility and rippling of the bag versus a capsulotomy where the tissue is simply released and this is often associated with very think or ectomorphic build patients where your concern with removing scar tissue may lead to complete loss of coverage of the implant causing visibility.

Capsular contracture is one of the most common problems we see as breast specialists, both for augmentation as well reconstructive nature.  Patients must seek Board Certified Plastic Surgeons when considering breast revision surgery.



breast-assymetry-front_sm 1The case example below indicates a young female who desired a very natural full B, small C, final result that had slight breast asymmetry.

Upon reviewing her preoperative photos, it is obvious that the right breast is slightly smaller than the left and that the right inframammary fold is higher than the left.

The patient desires to have natural result and, however, has a narrow base diameter of 12 cm and will do well using high profile cohesive silicone gel implants.  A 300 cc implant was placed on the right, 280 cc gel was placed on the left.  This was done using the dual plane technique and through the periareolar approach underneath the areolas.

breast-assymetry-side_sm 1These results are six weeks postoperative, approximately 90% of the swelling is reduced, the implants successfully fall into the proper position by the use of an athletic sports bra without underwire for one month and an upper pole compression band that has softened and relaxed the muscle on the upper pole to allow the implants to fall into its natural position.

Patients over the age of 22 who desire the most natural results possible and have minimal breast tissue may have successful results using cohesive silicone gel implants of slightly different size volume in order to correct the asymmetry.



Television and radio are very impressive media for displaying all types of venues, including plastic surgery and plastic surgery products.  In general, programs on plastic surgery can be educational in documentary form, can be in entertainment form or can be a combination of both.  Shows such as Discovery Health Channel, The Learning Channel and Woman’s Entertainment that Dr. Linder has been on have allowed for a documentary of a woman’s life, showing her before and after transition.  In the near future, Dr. Linder will be performing a total body makeover on a patient who from out-of-state, who has lost more than her entire body weight after a gastric sleeve surgery.  She will undergo formal mastopexies with abdominoplasties and thigh liposuctioning procedures in order to regain her shape after a 180-pound weight loss.  She is presently 135 pounds.  This will be taped for documentary television in order to show this woman’s amazing transformation after her massive weight loss procedure. 

Plastic surgery performances can also be entertaining.  Some shows have allowed the doctors’ lives to be displayed, which can be very impressive as well as interesting, but may take away from the most important point, which is the actual transformation both psychologically and physiologically, and postsurgical results of the patient’s amazing transformation. 

We will continue to perform documentaries for television in order to educate the public and allow for women throughout the world to understand the best procedures and safest operation when considering plastic surgery of the body.



Patients arrive to see Dr. Linder weekly for their breast augmentation needs.  Whenever we consider a patient a candidate for implant surgery for elective purposes, it is very important to factor in the psychological aspects of the patient’s desire for this operation.  During the initial consultation, Dr. Linder does a thorough history and physical, as well as a psychological evaluation in his mind of each patient.  Most importantly, we’re looking at patients who have realistic expectations for this operation who have done a significant amount of homework and research on breast augmentation surgery so that this isn’t a spur of the moment life-changing event that may be irreversible. 

Body self-image is important to all women from all societies and cultures regardless of being in cities such as Hollywood, Beverly Hills or New York.  Women want to look beautiful no matter where they live in the world and therefore in our practice, as a breast augmentation speciality practice, it is important that Dr. Linder meet with the patient, usually twice, on two separate dates prior to this operation, confirming the validity of the original findings in terms of size, shape, goals and realistic expectations of each woman’s desires.  Psychology and plastic surgery go hand in hand.  Patients have specific reasons which may vary as much as the size and shapes of the implants.  It is not uncommon that patients are seen who are on antidepressant medications in our practice.  If necessary, a psychiatric evaluation or psychiatric clearance may be required as deemed necessary by the plastic surgeon

In general, after having performed thousands and thousands of breast augmentations and breast revision surgeries, Dr. Linder believes that breast implants in general have greatly enhanced the self-esteem of women on whom he operates throughout the world.  Dr. Linder will continue to perform this operation and at the same time critique the patient’s goals and hopefully fulfill desires from this operation.