Recently, I saw a patient who presented from Valenzuela with ruptured silicone PIP implants that were placed approximately four years ago. The patient is extraordinarily concerned, having had an MRI showing a ruptured silicone implant on the right. Recently, it was reported that over as many as 50,000 women, including almost 30,000 in the United Kingdom, may have received these silicone gel implants. They were also implanted in women from South America, including Argentina, Valenzuela, Brazil, London and Paris, France. These implants have been shown to have a significant incidence of rupture with silicone spillage. In fact, on March 31, 2010 a medical device alert related to the silicone gel filled implants by PIP were recalled through a U.K. supplier. Studies have shown that the performance and safety of the PIP breast implants were not in accordance with current expected standards. The recommendations have included that all women with PIP implants should be referred for an ultrasound. All women with ruptures or suspected ruptures should have both of their PIP implants removed as soon as possible.
In December 2011, reports from the French Publication Liberation stated that all women in France who received breast implants supplied by Poly Implant Prothesis or PIP, should have them removed immediately.
This patient that I saw yesterday has what appeared to be a ruptured right silicone implant and she will be brought to the operating room in the next two weeks to have the implants removed and replaced with FDA-approved Allergan silicone gel Natrelle implants.
I received for the third consecutive year the award “Talk of the Town California”. The award category is Cosmetic Surgeons and was presented by Celebration Media U.S. and Talk of the News. It is a privilege and honor once again to be recognized.
“Ratings are calculated based on consumer-review websites and blogs, social networks, business rating services and other award information to determine the top companies across the country. Only those high ranking businesses with a 4-5 star rating win the Talk of the Town News Customer Satisfaction Award.” http://www.talkofthetownnews.com/
TALK OF THE TOWN CALIFORNIA
Excellence In Patient Satisfaction – 2012
Rated by patients online and awarded to Stuart A. Linder, M.D. in the Cosmetic Surgeons category.
Celebration Media U.S.
Talk of the Town News
PANNICULECTOMY CASE STUDY
This case study shows a representative patient who presents with massive abdominal pannus, status post significant weight loss, status post gastric bypass surgery. The patient has lost well over 120 pounds and now has significant amounts of skin with a massive abdominal pannus. A panniculectomy can be performed in order to reduce the massive skin apron or pannus. It also is helpful as a functional surgery to reduce the mid and lower back pain in a similar fashion as to a breast reduction that reduces back pain from the upper back and the cervical region. This patient also presented with intertriginous rashes for over six months with dermatitis, contact dermatitis and tinea fungal infections. She was cleared by her internist, rheumatologist, orthopedic surgery as well as dermatologist for contact dermatitis and fungal infections.
She underwent a panniculectomy under general anesthesia using an endotracheal tube, given Ancef intravenously with no history of penicillin allergies. The panniculectomy was completely resected. The abdominal wall was tightened in the midline conservatively using O-Ethibond sutures. The massive skin was then redraped, excised and sutured down the edges of the wound with three large 10 mm JP drains placed for at least 7 to 10 days. Liposculpturing of the iliac crest rolls was accomplished to reduce the lateral fullness of the hip area.
Patients do particularly well with paniculectomies when they have a massive abdominal pannus or apron after a significant weight loss, either through lap band, gastric bypass surgery or simple exercise and dietary routines.
The 69th Annual Golden Globe Award presented on NBC January 15, 2012.
(AP Photo Matt Sayles)
The best dressed celebrities included superstars dressed in very bold colors. This included greens and teals. Best dressed stars included Reese Witherspoon wearing vivid red; Emma Stone in dark burgundy; Bernice Bejo in sequence Gucci dress, feathered; Laura Dern in sparkling green, Angelina Jolie in an off-white gown with red accent; Sofia Vergara with a perfect fit and colored deep purple, voted best dressed at the 69th Annual Golden Globe. All these dresses in a similar fashion showed perfect fit, allowing the proportionality and perfection of the female form to be displayed. These dresses showed timeless class with elegance and creativity, especially with the sparkles and feathering.
The gold standard with the American Board of Plastic Surgery for liposculpture is the use of tumescent technique. Tumescent liposuction is associated with three components. Number one is the tumescent fluid of lactated ringer or sodium chloride. This fluid is used to infiltrate into the fat specifically, hydrating the fat and allowing the contouring of the specific body part with reduction of contour surface irregularities and deformities. The second component is Lidocaine. Lidocaine is a numbing agent. Lidocaine allows for up to 24 hours of pain relief and is very useful for tumescent technique liposculpture. Finally, epinephrine, which is added in order reduce bruising and bleeding, as well as allows for vasoconstriction of the arterial blood vessels and thereby allowing for a great reduction of bruising in the postoperative period. Postoperative compression garments should be included at 6 to 8 weeks of girdles and abdominal binders to reduce the swelling as well as to allow for a confluent smoothing effect of the abdomen, hips, flanks and inner and outer thighs.
The picture here describes preoperatively a patient with significant lipodystrophy of the iliac crest roll hips, periumbilical lower abdomen, as well as the interomedial and posterolateral saddlebags and the infragluteal fold banana rolls. This patient underwent a 2 liter tumescent liposculpture procedure and is now six months postoperatively showing a nice contour softening of the inner and outer thighs, infragluteal fold as well as a reduction of the muffin top and hip area as well as the periumbilical fat.
Breast Implant Revision
Below is an example of a patient’s significant pectus carinatum with right posterolateral slanting of her chest wall. She has undergone augmentation mammoplasty procedure by two different surgeons with an unsatisfactory result. She has inadequate parasternal cleavage with lateral displacement of the implant, especially along the inferomedial portion of her right chest. In postoperative photos she underwent open capsulotomy medially with an inferomedial muscle release of the pectoralis major muscle and an inferolateral capsulectomy. The implants were then replaced from moderate profile to extra high profile style 45, 600 cc gel implant, now creating better fullness of the upper pole with a better cleavage. The patient has worn compressive garments for six weeks. The incisions are now healing nicely, although there is some redness associated with capillary telangiectasia and this should resolve in the next three months with BioCorneum and vitamin E therapy.
Severe carinatum and reconstruction should only be performed by Board Certified Plastic Surgeons as these are very difficult surgeries in order to regain cleavage, especially with lateral and posterior displaced chest walls.
NEW YEAR! NEW YOU!
There is no better time than now to get the body that you desired through the years. Whether it is associated with hypoplasia or small breasts or a full mommy makeover with implants, breast lifts, tummy tucks or total body liposuction associated with weight gain throughout the holiday season. If diet and exercise cannot get you to the shape that you desire, tumescent liposculpture may be an excellent decision. 2012 will be an excellent year. We look forward to serving our patients worldwide for their breast revision, breast reconstruction, breast enhancement, augmentation, breast reduction, lifts, tummy tucks and full body liposculptures.