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Monthly Archives: June 2010

BREAST CAPSULOTOMY RECOVERY

EHOW.COM
HOW TO DO JUST ABOUT EVERYTHING

eHow_LogoAn interesting article is written by Mark Mingaman, who is a contributing writer for eHow.com, specifically to breast revision surgery.  This is the second article Dr. Linder has been quoted on for capsular contracture.  Dr. Linder describes that 15 to 20 percent of women who have augmentation will experience capsular contracture.  The significance is associated with the body’s immune system performing a capsule, a protective wall, around the implant. 

With respect to the procedure, capsular contracture can occur as soon as four to six weeks after original surgery.  It simply under capsulectomy is opened with an electrocautery device and a thin amount of the breast tissue will be removed around the capsule in order to reduce hardening and pain, however, to reduce visibility and palpability of the implant.  He also describes postoperative reduction of capsular contracture by the use of massaging, vitamin E and Accolate as well as the use of surgical dressings, and sutures should be removed in one to two weeks postsurgically.

AMERICA’S TOP PLASTIC SURGEON 2010

HONORS OF DISTINCTION AND EXCELLENCE

linder award 2010 photoDr. Linder is privileged and honored once again to be recognized in the “Guide to America’s Top Plastic Surgeons.”  Being chosen for this listing is an honor and is an impressive achievement being placed among the nation’s most excellent physicians.  Dr. Linder is appreciative and thankful for being included with a group of highly selected Board Certified Plastic Surgeons throughout the country.

BREAST ASYMMETRY METHODS FOR RECONSTRUCTION

Patients present to my office monthly for breast asymmetry repair. Patients are very unhappy with the appearance of their breasts, especially when one is significantly larger or a different shape and/or size then the other. In fact, breast asymmetry is a very commonly searched term on the internet. In general, breast asymmetry is associated with different size breasts, as well as shapes that may be different, such as tubular breast deformity, as well as sagginess or skin laxity of one or both breasts, which also leads to a symmetric appearance. As a result, the Board Certified Plastic Surgeon needs to appreciate both volume and skin laxity discrepancies on both breasts. Asymmetry in general with most women’s breasts is quite normal. However, when it becomes one-half to greater than one cup size in difference, patients can become very distraught. Younger patients often present for breast asymmetry reconstruction, often presenting with their parents, in order to repair the breasts and make them appear and feel normal. Most of the women do not want to have an exaggerated or enlarged appearance, rather they want to recreate a symmetric, even appearance with possibly a slight increase in volume.

Our first case is a breast asymmetry or the young 18-year-old female presents with severe right breast hypertrophy in which the left breast underdeveloped and the right one became enlarged. A reduction mammoplasty on the right with a small implant lift on the left allowed for good symmetric repair of the upper breast as well as elevating the nipple areolar complexes even bilaterally. She underwent, of course, the anchor scar which is evident. The scar is well worth the tradeoff of her now normal appearance and symmetric, even breasts.

CogenitalAsy1

The second example below shows a significant asymmetry in which the left breast shows a tubular-like deformity with pseudo-herniation of the breast tissue into the nipple areolar complex, poorly defined inframammary fold and loss of complete volume. The right breast on the second example shows grade 3 ptosis in which the nipple is well over 3 cm below the fold. As a result, this patient underwent an augmentation mammoplasty procedure bilaterally with invariably different size implants, as well as a mastopexy on the right breast using the inferior pedicle Wise-pattern technique or anchor scar. Her postoperative appearance shows symmetric, even breasts with the nipple also at the same position.

CogenitalAsy2

A final example shows significant breast asymmetry of volume only. This patient does not require any form of lift or reduction. Through a periareolar incision and a dual plane technique, high profile saline implants were placed behind the muscle, 520 cc on the right and 420 cc on the left. The 100 cc difference gained us approximately one cup size in volume on the right, evening out her breasts beautifully.

CogenitalAsy3

In conclusion, breast asymmetry is an extremely common problem that we see every day as breast specialists. Doctors performing reconstruction for asymmetric breasts should be Diplomates of the American Board of Plastic Surgery. In other words, Board Certified Plastic Surgeons, who have tremendous experience and excellent judgment on how to reconstruct breast deformities in women in general.

APPROACHES FOR BREAST AUGMENTATION

In our Beverly Hills practice we perform breast augmentations using high profile smooth round saline breast implants placed in the dual plane technique. The implants are placed half under the muscle and half over the muscle on the lateral half of the breast. The incision site that we prefer is under the areolar, called the periareolar approach because it allows the implants to be placed safely and predictably with excellent visualization of all anatomical structures during the surgical dissection.

The periareolar approach is especially useful when women have any degree of sagginess or ptosis to the breasts because it allows accurate release of the pectoralis muscle along the sternum and along the inframammary fold. It also allows the pocket dissection to be quite nicely made and as precise as possible in that you are directly above the area being released and the pocket being open.

breast augmentation

POSTOPERATIVE CARE

Postoperatively, our patients have dressings removed on the next morning. The Bias wrap is removed. The patient is placed into an athletic brassiere. Dry 4 x 4 gauze dressings are placed on the incision sites and if necessary, an upper pole compression strap is used in order to soften the upper part of the pectoralis muscle and allow the implants to settle to a normal position.

The patients are always seen one week later at which time the dressings are removed and now replaced twice to three times a day for the next seven days and sutures are removed on day 14. At this time they continue with the strap as necessary and a sports bra and the area is kept clean and dry.

FUTURE BREAST IMPLANT MAINTENANCE

Normally, a regular bra should be worn throughout the woman’s life. Under-wire support helps to maintain their position. Athletic brassiere should be worn at night in order to prevent gravitational descent or falling of the breast implants. Vitamin E or Mederma can be used on the scars for up to one year.

THE DR. LINDER BRA COMING SOON

dr_linder_bra_comingsoonThe Dr. Linder Bra, Trademark TM will be a line of Dr. Linder Products TM coming soon, in the next couple of months.  The Dr. Linder Bra was developed by Dr. Stuart Linder, Beverly Hills Plastic Surgeon, who is a specialist in breast surgery, performing and placing over thousands of breast implants.  Having had thousands of women describe problems with the brassieres that they have worn, i.e., athletic sports bras, sleeping bras and post-surgical bras, he has developed the Dr. Linder Bra.  The Dr. Linder Bra will be sold in high specialty boutiques throughout the Los Angeles area as well as on the internet at the www.linderproducts.com website, through Media Temple, Infomercials and future Home Shopping Networks/QVC and larger distributing retailers. 

Indications for use of The Dr. Linder Bra include: 1) as a sleeping beauty bra for women, with or without breast implants, to maintain the shape of their breasts throughout the evening so as to not have continued or recurrent skin laxity and loss of firmness to the breast; 2) as a training bra that can be used for the aerobic and anaerobic workouts to maintain the shape of their breasts during vigorous athletic activities as well as during Pilates; 3) as a pregnancy bra, due to the patented adjustable straps on the side of the chest wall, they can be adjusted to three different sizes and can be used for women in their 9-months pregnancy period as well as post-pregnancy during breast feeding; and 4) can be used post-surgically for breast cancer as well as elective cosmetic breast surgical procedures, including breast reduction, breast augmentation, mastectomy as well as breast cancer reconstructive patients. 

This Bra is not a surgical bra per se, but rather 24/7 hour bra that again can be used for training, sleep bra and beauty bra to maintain women’s breasts, every day bra to be used throughout the world, as well as for pregnant women whose breasts will enlarge over nine months and finally for post-surgical patients. 

The Linder product line will include The Linder Sport, which is the Linder Bra without the zipper in the front as well as The Linder Band, which will be useful for the abdominal area to reduce the abdominal midriff area up to two inches.  The Linder Bra manufacturers with the highest quality of approximately 95% cotton and 5% Spandex as bi-directional stretch, which thereby means has compression which will also allow women to perspire without development of consistent sweat within the bra.  It has excellent evaporative properties and will also have the adjustable straps on the sides with the Ford Steel Clip System which can be adjusted in three different sizes along the chest wall diameter.  This is a very unique bra.  It has been trademarked and is patent-pending at this time.  Manufacturing is occurring and should be completed in the next couple of months. 

Look forward to the informercial as well as selling of the products in multiple stores as well as training stores, sporting good stores and pregnancy stores for women.  We are very excited about The Dr. Linder Bra which will be very useful for women throughout the world for all their maintenance as well as training and post-surgical pregnancy needs.

Breast Revision Surgery Information

E-HOW.COM
INTERNET MEDIA

eHow_LogoAn interesting article was written on Breast Revision Surgery on e.How.com on June 14, 2010.  It discusses issues on breast revision and breast reconstruction, citing references of the Mayo Clinic, American Society of Plastic Surgeons and Dr. Stuart Linder’s information on breast revision associated with breastrevisionsurgeon.com.  In general, e.How.com is an interesting new internet site that shows many aspects of genres, including plastic and surgical procedure of breast augmentation, breast revision, silicone versus saline implants.  We are always thrilled to be included in articles from internet sources associated with breast augmentation and breast revision surgery.  The article can be found at drlinder.com  Articles and Publications, Internet Media category.

Information Regarding Plastic Surgery

WWW.AMERICAN-PLASTICSURGEONS.COM
blog-american-plasticsurgeonsThe American-PlasticSurgeons.com website was created to help educate patients throughout the world, both national and international in hot topics and issues in plastic surgery.  This is a weekly blog in which Dr. Linder acts as “Dr. Body,” and Dr. Robert Kotler as “Dr. Face.”  Topics in these blogs have included “Plastic Surgery by Two Cosmetic Plastic Surgeons at Once,” “Plastic Surgery Marketing Techniques to Avoid,” American Plastic Surgery and Infections,” “American Plastic Surgeons and American Way Magazine,” “Plastic Surgery World Capital,” “American Plastic Surgeons Help to Protect the Public,” “Plastic Surgery’s New Rules,” “Plastic Surgery Virtual Visits with the Surgeons,” “Plastic Surgeons Write to Drs. Face and Body,” “American Plastic Surgery Articles, News, More News and Views,” “Plastic Surgery Articles, What’s New and Useful,” “Plastic Surgery in Hollywood, What’s Wrong,” “American Plastic Surgery for Teens,” and “American Plastic Surgeons, Do-Over Specialists.”  These topics are extraordinarily interesting, as the description is laid out as if you are reading a magazine or newspaper article.  Dr. Linder acts as Dr. Body, specifically discussing issues on body sculpting, breast, abdomen and lipo contouring and Dr. Robert Kotler, facial plastic surgeon, describes the same topic with a perspective and flair for facial plastic surgery, including rhinoplasty, face lifts, brow lifts and chemical peels.  

This website has also been dedicated for international travelers, coming from Europe, the Middle East, Russia, the Caribbean and Asia, as both Dr. Linder and Kotler have international clients.  These surgeons also work concurrently on patients during the same operation.  For example, Dr. Kotler may do a full face lift or rhinoplasty while Dr. Linder performs the augmentation mammoplasty, tummy tuck or lipo contouring under the same general anesthetic.

INTRODUCING THE LINDER BRA

Because Dr. Linder’s practice is heavily involved with breast surgery, including breast augmentationbreast revisionbreast lifts and breast reductions, and having seen countless number of thousands of women and placed thousands and thousands of implants over the last 13 years, women have discussed with him their need for specifics in a bra. The specifics would include compression, comfort, adjustability of straps along the sides of the bra and a bra to maintain their breast shape during training exercise as well as sleeping. As a result, the Dr. Linder Bra will be coming to stores, internet, and infomercial and shopping networks in the near future. The Dr. Linder Bra’s functions are four-fold:

  1. As a sleeping or beauty bra to be worn every night for all women, with or without implants, to maintain the shape of the breast and to prevent skin laxity, ptosis or sagginess of the breast. The Linder Bra has nice compression associated with chest wall diameter and fitting to the breast itself rather than cup size.
  2. A training workout sports bra. This bra can be during aggressive workouts, including palates, aerobic, anaerobic workout as well as body building. This will help to maintain the breast, allow compression and prevent breast movement which may increase stretch marks, skin laxity and sagginess of the breast over time.
  3. Pregnancy bra. The Linder Bra is excellent for this as it is adjustable and has a three-clip design along the sides which will allow for taking the bra in and out during nine months of pregnancy.
  4. As a post-surgical bra, both for cosmetic elective and reconstructive cancer patients. Very useful for immediate post-surgical wear. Dr. Linder normally places this on postop day one, after removing the Bias wrap from the previous day surgery.

There will also be the Linder Sport, which is the Linder Bra without the zipper and clip system in the midline as well as the Linder Band, which will be used for abdominal compression. The infomercial should be out in the next six to eight weeks on worldwide television. The internet site via Media Temple is from www.linderproducts.com.

Entertainment Tonight Liposuction Technique

CBS SPECIAL
LINDER LIPOSUCTION TECHNIQUE

ET_LogoRecently played both on the East and West Coast, was a special segment on Cellulite and Celebrities with Cellulite. Dr. Linder acts as a consultant for Entertainment Tonight. He discussed issues on cellulite with patients and celebrities and specifically that there really are no surgical corrections for cellulite, including liposuctioning or non-invasive procedures. Diet and exercise may be helpful, but prevention and maintaining a healthy lifestyle is most important.

The segment on Entertainment Tonight included Linder Bi-Directional Liposuction Technique using both 4 and 3 mm triple lumen Mercedes cannulas and localized deep fat deposit areas of the upper iliac crest roll in order to remove the gene roll fat in both the vertical and oblique planes by using the 4 mm deep and the 3 mm triple lumen Mercedes tip cannula around the superficial in both the transverse, vertical and oblique fashion to contour the hips nicely and reduce the upper bulkiness above the gene line. The video on the media page is up for your review. Hope you find it entertaining as well as interesting, as this has been a successful procedure that Dr. Linder performs weekly on his patients.

Bottoming Out, Beverly Hills Revision Surgery

Patients present to Dr. Linder every week for revision surgery. This is one of his fortes. Breast revision surgery requires experience, judgment and talent and many years of experience in performing augmentation mammoplasty as well as breast lifts, breast reductions and breast enhancement surgeries. Combining all of that general knowledge will increase your chances of having successful secondary or revision surgery.

bottome out 106 a 19038

Bottoming out occurs when the implant gravitationally descends, lowering in the pocket and the nipple elevates within the pocket. The nipple may actually end up on top of the breast which leads to a severe deformity referred to as “bottoming out.” This can occur due to the pocket technically being made too low and the inframammary fold ending up low on the chest well or due to with time patients not wearing supportive brassieres, including underwire bras during the day and sports bras at night or sleep bras which will help to maintain position. If you think about it, it is difficult for the inframammary fold to maintain a large, large implant and over time without support of the fold, the fold may lower and fall. Ways to impair it include internal capsulorrhaphies (tightening the capsule into itself), autologous dermal matrix, including AlloDerm and allographs, which can be quite expensive, as well as neo-pocket formation and autologous dermograph placement or a simple inframammary tightening procedure with an inframammary lift, removing the skin around the inframammary fold, which may elevate the fold and then tighten the lower breast, and recentralize the nipple areolar complex into the middle. (Please see the following example of a severe bottoming out.)

bottom out 13 15765

Bottoming out surgery can be very difficult to repair and therefore, it is most important during original surgery that the implants be placed through an approach which is simple, such as the periareolar approach, where the inframammary fold can be lowered absolutely as accurate as possible and not too much.

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