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Monthly Archives: May 2012

SEVERE CONGENITAL BREAST ASYMMETRY

The patient presents with severe congenital breast asymmetry.  She will undergo surgery today.  She is a conventional case of asymmetry from birth which is associated with a larger breast on one side, showing some laxity of the skin as well as stretch marks and grade 2 ptosis.  Her left breast shows a hypoplastic breast.  Notice the nipple areola is significantly smaller on the hypoplastic breast then the right.  This may be variant of Poland syndrome where there is congenital absence of the sternal head of the pectoralis major muscle as well as very hypoplastic breasts with a small nipple areolar complex.

This patient will undergo augmentation mammoplasty procedure in the dual plane technique, using high profile saline implants, 400 cc on the right and 500 cc filled to 550 cc on the left, in order to regain a 1.5 cup size, increasing volume on the left versus the right.  There will also be radial striation on the left inframammary fold to release the breast in order to allow it to fall to a similar position as the right.  It has been instructed to the patient that she will wear an upper pole compression band for one month and tissue expansion exercises, left side greater than the right, in the near future.

Congenital breast asymmetry is a difficult surgery to correct, requiring experienced Board Certified Plastic Surgeons in order to determine the volume discrepancy in order to regain a normal appearance to the breast.

RUPTURED TEXTURED SALINE IMPLANT VIDEO

The video below is an excellent example and description of a patient recently that had ruptured textured saline implants.  The patient had implants placed 14 years ago, did not have any implant information; however, she had a deflation of the left implant with the left breast showing significant loss of volume as well as severe asymmetry.

In the operating room it can be seen that the patient’s implant came out quite smoothly, although textured.  Sometimes the textured coating is only lightly adherent to the capsule surrounding it.  A small portion of the capsule was removed concurrently with the implant.  The textured implant upon removal from the video is yellow in appearance, indicating a chronic rupture, with no fluid within in the implant, also indicating that this implant is completely ruptured and there is no volume whatsoever.  Scar tissue contracture or round implants that have collapsed over years can be very severe.  After explantation of this implant, the pocket was irrigated, capsulectomy was performed and the implants replaced with high profile silicone gel implants.

For further information on ruptured implants, please refer to www.rupturedimplants.com, Dr. Linder’s newest and most informative site on ruptured implants worldwide.

New Ruptured Implant Website

Patients come in every week  for breast revision surgery due to ruptured implants. I felt compelled to develop a site that would help explain and educate patients when confront with a rupture.

I am very excited to announce that www.rupturedimplant.com is now live and I hope it provides patients with the information need to make good educated decisions.

Abdominoplasty African American Women

Tummy Tuck

Abdominoplasty or tummy tucks when performed with women of color may have a higher incidence of scar formation along the lower Pfannenstiel or C-section scar associated with abdominoplasty.  Patients of color, including African-American women, Filipino and Middle Eastern women should be apprised of the situation of the possibility of keloids, hypertrophic scarring, widespread scarring, hyper- and hypopigmentation of scars associated with a tummy tuck procedure.

In the example, this patient has undergone a full abdominoplasty procedure.  She is a 48-year-old African-American female, having delivered two children, with excessive skin laxity in the lower abdominal wall with rectus diastasis.  The patient underwent an extensive full abdominoplasty up to the subcostal margin dissection with plication of the midline rectus sheath.  She underwent liposculpture of the iliac crest rolls.  The before photo shows stria from the umbilicus down to the suprapubic region.  The postoperative photo shows a full tummy tuck with the scar hidden low, just above the hairline of the suprapubic region, extended to the anterior superior iliac spine bilaterally and a circumferential incision around the umbilicus has healed well without hyperpigmentation, keloid or hypertrophy.  Lowering the scar on patients of color will help to reduce the visibility of this incision through underwear as well as through swimwear.  It is vital that patients of African-American origin as well as patients with increased pigment discuss the scarring and the possibilities of these problems thereafter.

MRI DIAGNOSIS OF RUPTURED SILICONE

Patients who present with silicone gel implants may present with ruptured silicone implants, although it is difficult to detect clinically.  Patients should undergo every two to three years postaugmentation or augmentation revision with silicone implants and MRI in order to determine the integrity of its shell or the bags.  Our patients are instructed that the MRIs are extremely important with silicone implants in that they allow the radiologist and the surgeon to determine a rupture intra- versus extracapsular.  The intracapsular rupture of silicone implants can be detected by what is called the Linguine sign.  The weightiness and black and white echo seen on the MRI is pathognomonic for the ruptured silicone bag.

The next four pictures represent a ruptured silicone on the right.  Notice the Linguine sign as well as the medial rupture of the implant on the right implant.  The left implant is completely intact.  There is no evidence of loss of integrity of the shell or Linguine sign.  The implants that rupture in silicone patients are referred to as “silent ruptures.”  This is different from saline implants that are referred to as “clinical ruptures” which can be diagnosed by visualization of the breast, showing an obvious asymmetry.  Remember that mammograms and ultrasounds can provide false positive or actually more often false negative results, indicating that the silicone implants are intact, but they are actually ruptured.

American Society of Aesthetic Plastic Surgery

ANNUAL MEETING “ASAPS” Vancouver, Canada

May 4 – 7, 2012

I recently attended the Annual American Society of Aesthetic Plastic Surgery Meeting in beautiful Vancouver, Canada.  This was an extremely interesting meeting and very informative with all aspects of cosmetic facial and body sculpting surgery procedures.  I attended courses in new techniques of breast lifting using the subareolar mastopexy approach, modified abdominoplasty surgery, as well as severe breast asymmetry and correction.  The conference included seminars with respect to dermal fillers, Botox and non-invasive fascioplastic surgery procedures, including a combination of Botox with hyaluronic acids, including Juvéderm and Restylane and Methyl Methacrylate Artefill.  In general, body sculpting procedures include the use of smart liposuction, vaso-liposuction as well as liposculpture of the breast.

This was an informative meeting.  It’s always wonderful seeing friends and colleagues from throughout the United States.  Vancouver itself was a beautiful and having the chance to fly to Victoria Island was quite amazing.

AMERICA'S TOP SURGEONS 2012

The Consumers Research Council of America is a company that evaluates and compiles lists of America’s Top Professionals.

It is a privilege and honor once again to be recognized for the fourth 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.

Severe Bottoming Out

RECONSTRUCTION INFERIOR CAPSULORRAPHY FOR

SEVERE BOTTOMING OUT

Patients present to my practice in Beverly Hills for severe deformities, including malposition, technical areas of breast implant placement and in this case severe bottoming out, complete collapse of upper pole of pocket causing inferior displacement of the implant and a bottoming out appearance.  This is a case example in which the patient will undergo both repair of the bottoming out with an inferior internal capsulorraphy sling as well as a left inframammary tightening procedure of a breast lift nature.  Intraoperative photograph shows complete collapse of the upper pole of the pocket with the muscle completely scarred down to just above the level of the 12 o’clock position of the nipple areolar complex.  The implant has been pressurized down inferiorly and is approximately 1.5 inches too low.  Inferior capsule has been released and a small portion has been excised and has been sutured in place acting as a sling.  Skin was then removed and this double tightening procedure has brought the implant level back up to the normal position of the left side.  This is a classic example in which a thick capsule can be used as a sling in a capsulorraphy form to treat a patient with severe bottoming out.

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