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Dr. Linder's Blog

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Monthly Archives: December 2009

CAPSULAR CONTRACTURE BEVERLY HILLS

Breast Revision: Capsular Contracture

What is capsular contracture?  Capsular contracture is simply scar tissue hardening around implants in which the patient can have severely disfigured and painful breasts.  We see this every week, as Dr. Linder specializes in breast revision surgery, seeing patients both in his Beverly Hills office as well as in Las Vegas

Capsular contracture is associated with scar tissue.  Scar tissue is associated with three components.  The capsule hardening is associated with collagen, myofibroblast and blood vessels which can all harden around an implant, the prosthetic device which can lead to severe encapsulation and painful breast deformity and disfigurement.  Please refer to www.breastrevisionsurgeon.com to look at the galleries of capsular contracture patients.

Before Photo(another doctor) After (Dr Linder)

Before Photo (another doctor) After Photo (Dr Linder)

There are four classes of capsular contracture referred to as Baker scale.  Baker I is no capsular contracture with a soft, viable breast.  Baker II is a palpable capsular contracture where it feels hard, but there is no disfigurement.  Baker III is disfigured hard and palpably hard breasts.  Baker IV is considered the worst in which there is disfigurement, hardening, pain and an often cold, tight scar tissue contracted breast, often associated with superior retroposition of the implant with severe tenderness even with mild palpation. 

Capsular contracture is one of the most leading causes of revision breast surgery for both breast augmentation and breast cancer reconstruction.  Only Board Certified Plastic and Reconstruction Surgeons should be performing these difficult revision surgeries.  Dr. Linder looks forward to seeing patients in 2010 for their breast revision and breast augmentation needs.

HOLIDAY PLASTIC SURGERY in BEVERLY HILLS

HOLIDAY PLASTIC SURGERY

No better time than the holidays to undergo your cosmetic surgery procedures.  Dr. Linder operates throughout the holiday season from Christmas to the New Year.  This is an extraordinarily busy time for plastic surgeon, but it is an excellent opportunity for patients to recover, as many patients have vacation and holiday leave during this time of year.  We also perform multiple combination procedures and total mommy makeovers during the holiday season, including augmentation breast lifts, tummy tucks and lipo-sculpturing. 

Dr. Linder and his staff send to all of his patients and to everyone out there a very happy holiday and a safe and healthy 2010.

Aerolar Reduction Beverly Hills

Aerolar Reduction

Areolas can be reduced in size when they are greater than 4.2 cm.  In general, as Board Certified Plastic Surgeons, we vary the range of nipple areolar complexes from 3.8 to 4.4 cm in size, often associated with the proportionality of the woman’s breast and figure.  We use 4.2 cm cookie cutters or 42 mm cookie cutter patterns in breast lift and breast reduction procedures in order to remark and reduce the nipple areolar complex to a smaller uniform size.  I personally use 4.2 cm on the majority of my breast reduction and breast lift surgeries.

Breast Reduction Before and After Photo

Aerolar Breast Reduction Before and After

Reducing an areola that is quite large, for example, 6 to 8 cm down to 4.2 without a vertical incision, although may be easy to do, the final results may be quite poor.  The reason is areolar reduction performing a Benelli or round block technique, often leads to pin cushioning around the areolar which thereby may lead to radiating sun scarring appearance as well as widespread scars.  As a result, I frequently persuade my patients not to undergo areolar reductions without a vertical component or a vertical lift with the areolar reduction.  The vertical lift actually will reduce the wide-spreading of scars around the nipple areolar complex by eliminating tension around the areola and bringing it to below the nipple areolar complex at the 6 o’clock position in a vertical fashion in which the scars usually spread less.

RUPTURED SALINE IMPLANTS BEVERLY HILLS

Whenever a patient presents with a ruptured implant, we highly recommend that the implant be removed and replaced as soon as possible.  Ruptured saline implants are usually clinically obvious as one breast will be significantly smaller than the other.  The crack or rupture can occur either from the shall itself, most commonly with textured implants, where they have crease cracks and they develop leakage, or from a valve where the one-way valve becomes bi-directional and fluid leaks through the valve and it’s now no longer unidirectional.  As long as an implant remains in the body, scar tissue will continue form around it and wall off the implant, reducing the size of the pocket and causing increasing encapsulation which may make it more difficult to regain a normal appearance to the breast.

Ruptured Implant Photo  After Breast Revision

Before and After Breast Revision Photos

As a result, whenever a woman has a ruptured saline implant, we recommend having it removed and replaced within the next 7 to 10 days.  The operation should be performed under general anesthesia.  We usually will perform a periareolar incision, remove the implant, irrigate out the pocket and then open up the scar tissue as necessary, either through an open capsulectomy removing the scar tissue or a circumferential open capsulotomy, releasing it, depending upon the thickness or viability of breast tissue surrounding the bag.

BREAST REVISION, DOUBLE-BUBBLE

BREAST REVISION, DOUBLE-BUBBLE DEFORMITY

Patients who present frequently for breast revision surgery to my Beverly Hills as well as Las Vegas practice, present with double-bubble deformity.  By definition, a double-bubble deformity is when the implant is too high or superiorly retropositioned and the skin over-drapes the implant in an unnatural appearance.  This can be fixed using several different techniques due to the extent and degree of the double-bubble deformity as well as the amount skin laxity.  Through the below example, the patient only required open capsulectomies, inferior open capsulotomy, releasing scar tissue, releasing the parasternal and the lateral attachments of the pectoralis major muscle, which had not been done correctly in the last three previous attempts.  The entire pocket was opened up basically and the muscle was completely released along the medial as well as the lateral portion of the chest wall.  This will allow the implant to settle to its normal position.  In order to maintain that position, the patient will perform postoperative tissue expansion exercises as well as wear an upper pole compression band that will maintain the opening of the lower pole of the breast pocket. 

The postoperative result on this patient, as you can see, is an obvious, more normal appearance to the breast with lowering of the implant, which should maintain its position permanently with time.  Patients are instructed to wear sports bras and athletic brassieres until four to six weeks and complete settling has occurred. 

Double bubble deformities are a challenge.  They require experience and judgment.  Board Certified Plastic and Reconstructive Surgeons, who specialize in breast surgery, should be able to fix this unfortunately

Former Miss Argentina dies after plastic surgery

COMPLICATIONS AFTER PLASTIC SURGERY LEADS TO DEATH OF MISS ARGENTINA

Three days ago, on Nov. 29, 2009, the former Miss Argentina died. Now, it’s evident as reported in the news that her recent and tragic death resulted from complications that developed after she underwent a cosmetic surgery procedure. According to multiple reports, Solange Magnano was 37 years old, and was transferred from a clinic in Buenos Aires, Argentina where she underwent elective surgery on her buttock area on Wednesday.

Miss ArgentinaAlthough her death is under investigation, some sources indicate that she may have had a pulmonary embolus which occurred from an injection of a certain substance into her buttock area. Sources state she was rushed to the hospital on Friday after suffering a pulmonary embolus. Juan Carlos Seiler, the former president of Buenos Aires Association of Plastic Surgeons, suggested that “the doctor who performed the procedure might not have been a real professional from an approved cosmetic surgery center.” It is indicated that some type of injectable substance (not specifically described although it may have been silicone or fat injection), led to a pulmonary embolus and death. It would be interesting to uncover facts on her death as to what truly occurred. This is once again why cosmetic surgery should always be considered a serious operation and not considered as simple as a haircut or having a manicure. Even injections of simply autologous fat, if not performed correctly, can lead to very serious complications including deep venous thrombosis and pulmonary embolus which is consistent with the death of Miss Argentina of 1994.

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