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Dr. Linder's Blog


Monthly Archives: April 2011


Honors Of Distinction & Excellence – 2011

It is a privilege and honor to be recognized for the third year in a row 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.  I’m appreciative and thankful for being included with a group of highly selected Board Certified Plastic Surgeons throughout the country.

Beverly Hills Trans-Umbilical Augmentation


In my practice, having performed thousands and thousands of breast enhancement surgeries, I found that safety and predictability are of utmost importance in achieving excellent results in breast augmentation surgery.  I have seen countless numbers of patients who have undergone the trans-umbilical augmentation mammoplasty procedure, many with unsatisfactory results.  My concerns with this approach are the predictability and positioning of the implants.  Placing an implant at the umbilicus through a trocar under the muscle can be extremely difficult for any talented surgeon.  Obtaining cleavage, releasing of the parasternal attachments of the pectoralis major muscle and operating on patients who have any degree of skin laxity or ptosis may lead to a very unnatural appearance to the breasts using the trans-umbilical approach.  I personally do not use this approach and have done a significant number of breast revision surgeries on patients with double-bubble deformities, malpositions and severe bottoming out.  My favorite approach is the periareolar approach with the incisions made under the areola and the implant is then placed subpectoral in the dual plane technique.  The parasternal attachments of the pectoralis major muscles are easily and predictably released and thereby the implants are positioned in a correct pocket.  Also, lateral dissection beyond the lateral board of the areola can be more easily performed with less lateral malposition of the implants leading to poor cleavage. 

In summary, I do not favor trans-umbilical augmentation mammoplasty procedure.  Although it may had a scar on the umbilicus and there may be no incision site on the chest wall, I do not believe it is worth the tradeoff of difficulty in obtaining perfect positioning of the implants, perfect release of the muscle and preventing lateral displacement of implants due to improper release of the lateral breast tissue through a trocar.

Natural Looking Breast Implant


Style 15, Allergan/Natrelle silicone gel implant, is a very natural breast implant.  It is a moderate plus profile silicone gel, not too narrow and not too wide.  Advantages include a very natural appearance.  Please see photograph to the left of a 371 moderate plus silicone gel Allergan implant placed in a woman with an ectomorphic body, minimal breast tissue and thin pectoralis muscle development.  The greatest disadvantage, however, is there is still significant visibility, palpability and rippling notable on patients who are this thin with a Style 15, with minimal amounts of body fat and very thin muscles, and with prominent costochondral ribs that are notable, the moderate plus gels do have visibility along the lateral breast and sometimes along the medial breast as well, especially when patients are bending down or bending over.  This should be noted to the patient prior to the operation during consultation and although these are more natural and give a natural upper pole slope, their visibility and rippling can be significant.  In thinner women who desire minimal or less visibility or rippling, I more often prefer either Style 20 or Style 45 extra high profile gels which greatly will reduce the incidence of rippling.  Of course, there will be more upper pole fullness, but when placed under the muscle they still have a somewhat natural appearance as well.

Coverage For Insurance Regarding Breast Reduction


Breast reduction surgeries are functional operations. Patients present with horrendous symptoms of massive amounts of back pain, neck strain, grooving of shoulder blades, rashes and so forth. All insurance companies have different policies and plans. PPO plans often will cover breast reduction surgeries if the patient is going to be having a certain amount of tissue removed per breast and the symptoms have been documented. They often require documentation of upper back pain and shoulder pain not associated with any other diagnosis, including photographs showing grooving along the shoulder blades, as well as frontal, oblique and lateral views of the breasts. They may require documentation of ulcerations of skin as well as documentation of physical therapists and chiropractors showing failed measurements and may also require radiographic evidence of x-rays showing kyphosis or vertebral column abnormalities associated with the massive breasts. Intertriginous or chronic skin breakdown that is not responsive to the dermatological medications may also be needed to be proven. The amount of breast tissue to be removed is different per policy. There are total body surface area policies where height and weight ratios are reviews and times by a factor in order to give a specific gram weight that must be removed per breast. The height and weight of the patient are always required and those are often needed to determine the amount of tissue removed per breast.

Reduction mammoplasty is a functional surgery. This is a surgery where patients do great. If the tissue is removed appropriately and safely, the results are fantastic and the patients couldn’t be happier.

Dr. Linder Bra Website Creation

linderbraThe new Dr. Linder Bra website is now up.  It has been completely transformed to allow for easy maneuvering from page to page, allowing you to review the different bra sizes and colors on the store page.  There are also multiple pages associated with specific uses of the bra, including maternity, sports bra, post-surgical, beauty, training and sleep bra.  The commercial is embedded as well so that women will be able to see the bra in action, with women wearing the bra while training, working out, sleeping and during pregnancy. 

I hope this website will allow women throughout the world easy access to the new Dr. Linder Bra, one of the most versatile, compressive sports, training, beauty and post-surgical bras in the world with the triple clip, adjustable straps on the sides to 2 inches, a special reinforced padding along the sternal portion of the breast to allow for softness and comfort during vigorous training and exercise.

Breast Revision Surgery Downsizing

Every week I see multiple patients who desire to have implants replaced with smaller implants and have the same question as to what will the pocket look like, how will the skin appear after the reduction in volume.
In many patients, it is difficult to determine the amount of skin tightening that will occur after significant downgrade in size of saline or saline implants.  In general, reducing an implant by over 100 to 150 cc may lead to significant skin laxity which may require a breast lift concurrently with the implant exchange.  There is never a guarantee to our patients that there will be no skin laxity after implants are removed completely or a reduction in significant size.
Interestingly, the new style 45 extra high profile gel has allowed us to downsize certain patients up to 200 cc because of the increased AP projection and less lateral width and still maintain nice upper pole fullness without significant skin laxity.  The behavior of the skin after smaller implants are placed is different woman-to-woman and varies significantly.  In no way can any plastic surgeon guarantee that your skin will remain tight after a significant change in volume.

New York Times Cosmetic Surgery Statistics Review

nytimesIn the March 30, 2011 New York times, an article which discusses a decade of boosting breast size, had very interesting statistics, notably, the breast augmentations performed in comparison to facial plastic surgery procedures.  In summary, breast augmentation procedures continue to remain stable or are on the increase, while facial plastic surgery trends have shown a decrease in number of surgeries, including facelifts, nose jobs and eyelid surgery.  Statistics show approximately 296,000 augmentations performed in 2010 show a 2% increase from 2009.  The increase is almost 40% in breast implants placed annually since the year 2000.  Breast lifts have also been shown to increase since 2009 with over 90,000 lifts performed in the year 2010.  Of the 13.1 million cosmetic surgery procedures performed last year, there has been a 5% increase since the 2009 statistics were taken. 

We continue to see breast augmentation patients weekly and have performed multiple surgeries on these patients every week of the year.  Both saline and silicone gel implant patients arrive on our doorsteps for surgery almost daily.  We believe that the demand for breast augmentation, breast revision, breast lifts and breast reductions will continue to increase over the next 10 years and that the trend shown by the New York Times article is accurate.

Talk of the Town California 2011

Last week I recieved for the second consecutive year the award “Talk of the Town California”. The award category is Cosmetic Surgeons and was presented by Celebrationn Media U.S. and Talk of the News. It is a privilege and honor once again to be recognized.

Excellence In Patient Satisfaction – 2011

Rated by patients online and awarded to Stuart A. Linder, M.D. in the Cosmetic Surgeons category.
Presented By:
Celebration Media U.S.
Customer Care News

Talk Of the Twon