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Dr. Linder's Blog


Monthly Archives: April 2010

Double Bubble Deformity Beverly Hills


The below patient presents with severe Baker IV capsular contracture with malpositioning of implants, done through the transaxillary approach.  Her preoperative view shows complete distortion with superior retropositioning of the implant with hardening and a grotesque appearance to her breast.  The patient works in the entertainment industry and this is obviously distressful for her in that her breasts do not appear normal in way fashion. 

Breast Revision

In order to correct this problem, an open capsulectomy was performed bilaterally.  A new implant was replaced and lowered with an open inferior capsulotomy, anterior capsulectomy and a formal mastopexy using the inferior pedicle Wise-pattern technique was performed in an anchor-like fashion in order to remove the redundant skin.  Notice, her postoperative view with a normal appearance to bilateral breast, good symmetry, nipple areolar complex symmetry is excellent, and she now has a normal appearance to her breast. 

Double bubble breast deformities require skill, experience and judgment, which can be found with Board Certified Plastic Surgeons.



white houseDr. Linder has had the opportunity to attend the 2010 Aesthetic Society Meeting for the American Society of Aesthetic Plastic Surgeons.  Interesting course topics included Breast Revision Surgery, Surgery using Acellular Dermal Matrix or ADM as well as Neo Pocket Formation for Severe Breast Deformities, including Symmastia and Malposition of Implants.

Interesting courses also included Safer Sedation and Analgesia for Office Based Surgery, Optimizing Outcomes in Breast Augmentation as well as Revision of Breast Augmentation Mastopexy and Augmentation Mastopexy.

Dr. Linder also had the opportunity with his family to tour the White House, Capitol Hill as well as many of the fascinating monuments throughout the Washington, D.C. area.  This was an excellent informative, educational and entertaining meeting.

Launching Of New Website, Breast Implant Las Vegas.com



Breastimplantlasvegas.com will be launched in the very near future.  This site has been developed in order to educate patients with breast augmentation surgery in general.  We go through all the specifics and facts of breast augmentation surgery, including the history of breast augmentation, the chemical composition of silicone itself, the postoperative care and management of breast augmented patients, identification cards from your breast implant surgery, as well as postoperative recovery time.

With respect to saline implants, great detail is given as to the surgical technique and candidates for saline versus silicone gel implants.  With silicone implants themselves, the 7-year complication rate for primary versus secondary augmentation patients is given, courtesy of Natrelle Collections.  Placement of implants as well as implant shapes, including high profile moderate plus and moderate profile implants, are described in detail, including examples of before and after photographs.  Breast deformities are also described, including breast asymmetry, tubular breast deformity, pectus carinatum and pectus excavatum.  Photograph examples are also given. 

Finally, breast implant revision, which is a large component of Dr. Linder’s practice, is described with respect to breast asymmetry, capsular contracture, ruptured implants, double-bubble breast deformity, cleavage, both primary as well as revision, implant malposition, severe bottoming out, volume revisions, anatomically shaped implants, symmastia, implant explantation and scarring on the breast mound itself.  You may also refer to breastrevisionsurgeon.com and lasvegasbreastrevision.com  for more details on breast revision surgery.

Again, the main purpose of this site is to become an encyclopedia of wealth of information to educate women throughout the world, as well as Beverly Hills and Las Vegas, Nevada on breast augmentation and breast revision surgery itself.  I hope you find this very useful.

Hollywood Drives Consumer Interest in Aesthetic Procedures


TheAesthetic_03n042010Contributing editor, James Tager, does a fantastic job in describing Hollywood’s affect on consumer interest worldwide on plastic surgery procedures.  The lengthy article describes the affect of celebrities in Hollywood on cosmetic surgery throughout the world. 

I appreciate the opportunity to have been included in the writing of this article for the Aesthetic Guide Magazine.  In simple form, Bedford Drive, Beverly Hills, is not only filled with exceptional plastic surgeons, but is the home site for tens and tens of paparazzi day in and day out, enduring hours of waiting to capture photographs of the celebrities who wander down our block.  A day does not go by in which the cameras flash around our building and up and down Bedford Drive.  The appearance of celebrities from Marilyn Monroe to today’s super models and celebs has not changed all that much.  The intrigue and appetite of the consumer has only increased through the years.  Without a doubt, Beverly Hills and Hollywood drives women throughout the world to endure countless cosmetic surgical procedures, including Botox injections to total mommy makeovers.

The article is included here by PDF for your perusal.  I hope you find it entertaining, educational and enjoying.


cleavage repair Beverly HillsPatients present to my office weekly for breast revision surgery.  Cleavage is an important determinant and final result after breast augmentation procedures.  The  patient in the photos underwent augmentation mammoplasty procedure by a different surgeon with obviously poor cleavage.  This was done through the transaxillary approach in which the parasternal attachments of the pectoralis major muscle were inadequately released.  We see this very frequently with patients having poor to no cleavage and having laterally displaced implants due to inadequate release of the muscle attachments along the medial parasternal ridge from the pectoralis major muscle.  In order to repair this patient’s breasts and give her a reasonable amount of cleavage, the periareolar approach was performed.  The implants were removed and medial open capsulotomy and inferior capsulectomy were performed with a moderate plus silicone gel implant placed and very tight compression sports bra for six weeks postoperatively allowed, as you can see on the postop photo improved cleavage with medial Vectra forcing of the implants to the midline.  Notice, there wasn’t a significant change in size of the implant, rather the pocket was released appropriately, implants were then brought to the midline and compression allowed for stabilization along the implants towards the sternal region.  Cleavage is an important determination of final outcome of breast augmentation surgery.  As a result, the approach that we take, periareolar and dual plane technique, allows for safe and predictable results, including final cleavage.


Breast asymmetry reconstruction is a procedure that requires tremendous skill.  In fact, components of the operation include 1) augmentation mammoplasty procedure; 2) breast reduction; and 3) breast lifting procedures.  Only experienced Board Certified Plastic and Reconstructive Surgeons should be performing breast asymmetry surgical repair.  In general, breast asymmetry reconstruction requires changing one breast volume in order to create symmetry with the contralateral side. 

Example No. 1 below shows a patient with significant bilateral breast hypertrophy with Grade 3 ptosis bilaterally.  The right breast is a 36E size breast, the left is a “B.”  In order to properly repair her breast, reconstructing it, she underwent a straight breast reduction procedure using the inferior pedicle Wise-pattern technique on the right and a breast lift on the left with a small 200 cc saline implant.

1 Cogenital Asymmetry 1






Example No. 2 shows breast asymmetry requiring a larger saline implant on the left with a straight formal mastopexy on the right to regain symmetry. 

2 Cogenital Asymmetry 2






The third result shows breast asymmetry repaired with simply breast implants of different volumes.  The right implant was a 510 cc implant and the left 420 cc.  This allowed for excellent symmetry of her breasts. 

3 Cogenital Asymmetry 3






Breast asymmetry is an operation that requires skill and experience and the surgery leads to extraordinarily satisfied patients, especially when they are trying to recreate a normal appearance to their breasts.



In certain patients, especially those who are thin and have ectomorphic build, high profile implants are an excellent choice for augmentation mammoplasty procedure.  We place implants in the majority of patients, including this example below, using the dual plane technique, two-thirds under the muscle and one-third lateral above. 


High Profile Implants - Post Op

High Profile Implants - Post Op

The periareolar approach was used and the incision is made underneath the nipple.  Patients who are very thin, ectomorphic build and have very short inframammary folds may do well with a high profile saline or silicone gel implant because it will reduce the lateral width of the bag which maintains their tapered appearance, reduces matronly appearance and allows for a more soft appearance in the upper pole.  The oblique view shows a softening of the upper pole under the subpectoral major muscle.  This patient has done extraordinarily well and is the usual and typical case of a high profile saline implant placed in an ectomorphic built patient.


Excerpts from The Beverly Hills Shape, The Truth About Plastic Surgery, authored by Dr. Stuart Linder, Beverly Hills Plastic Surgeon, page 128. Candidates for Breast Lift. “Candidates for breast lifts usually include women who have a severe amount of sagginess to their breasts. This usually includes those individuals whose nipples are located below the inframammary fold. The inframammary fold is the crease under the breast and this is a demarcation line when the doctor determines the degree of sagginess. Referred to as ptosis in Latin. Where the nipple lines in relationship the inframammary fold gives us the degree of ptosis. Very severe ptosis with the position of the nipple well below the fold indicates a need for breast lift in which skin is removed both underneath the areolar and along the fold. This is what results in the anchor scar that we have discussed previously. In a breast lift the incision goes around the areola, down in a straight line from the areolar to the inframammary fold and then in a semi-circular line around the fold. This technique allows us to limit the amount of skin removal and hides some of the incision underneath the breast crease.”


In general, breast lifts are very successful surgeries if patients have realistic expectations and are accepting of the scarring. Remember that scarring is unpredictable and is a tradeoff for any breast liftbreast reduction or abdominoplasty procedure. For more on breast lifts, refer back to Chapter 13 of The Beverly Hills Shape, The Truth About Plastic Surgery.