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Monthly Archives: April 2013

Removal and Replacement With Formal Mastopexy

 SECONDARY AUGMENTATION MASTOPEXY

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The patient presents from Brazil.  Large implants, low profile, silicones were placed above the muscle, subglandular.  She has developed severe grade 3 ptosis and will do well with a secondary augmentation mammoplasty with style 45 silicone 500 cc extra high profile silicone gel and a complete formal mastopexy using the inferior pedicle Wise-pattern technique. Her before results showed severe grade 3 ptosis, low hanging breasts, and nipple well below the inframammary fold.  She did well with having low profile gels replaced with style 45, extra high profile, 500 cc implants showing on her after photographs excellent upper pole fullness.  In order to elevated the nipple and reduce the nipple areolar complex size, a formal mastopexy using the inferior pedicle Wise-pattern or anchor scar was performed.
photo-1-e1367021554834Her postoperative results are excellent.  She is at three weeks.  The vertical scar and inframammary incisions are healing nicely.  The sutures have all been removed.  In order to appropriately reconstruct patients with this degree of severe skin laxity, a complete breast lift using skin excised circumferentially around the nipple vertically and along the inframammary fold must be performed.

DR. LINDER IS NOW ON DR. OZ’S EDITORIAL ADVISORY BOARD

sharecare-people

Dr. Stuart Linder has more than 15 years of experience in body sculpting and reconstructive surgery, and is honored to be a member of the Sharecare Advisory Board. There are presently 19 board members each of unique medical specialties. Dr. Linder will represent the specialty of plastic and reconstructive surgery of the Editorial Advisory Board of Sharecare.

Sharecare is an innovative and interactive health and wellness website designed to provide a welcoming environment for everyone to “share care,” from consumers to health care experts. Created by cardiac surgeon, talk show host (“Dr. Oz”), and author Dr. Mehmet Oz and Internet entrepreneur Jeff Arnold (Founder/CEO of WebMDHowStuffWorks), Sharecare allows the public to obtain multiple expert perspectives regarding various health and wellness issues via an intelligent, social Q&A platform. Its goal is to achieve a collective IQ on health and empower consumers with essential information that will help them make smart health choice and take the appropriate actions.

I am proud to be a member of an Advisory Board that has the power to make an impact on those striving to live healthier lives. Specializing in numerous plastic surgery procedures, I look forward to providing my knowledge and professional perspective regarding a wide range of topics.

Double Bubble Breast Deformity

BEVERLY HILLS, CA

The patient presents with severe breast deformity associated with a double bubble breast.  Double Bubble breast deformities can be defined as an implant that is elevated upon the chest wall with the nipple over-draping it and found at the lower portion of the breast.

Before Photo

Before Photo

This patient’s before photos show severe bilateral double bubble breast deformity.  Notice the left side is worse than the right and that the implant is elevated superiorly on both breasts, the nipple is at the very bottom of the breast with skin laxity.  There are three requirements of reconstruction for double bubble breast deformity.  The first is an open capsulectomy, removing the scar tissue circumferentially around the implant and lowering the bag.  The second is replacement of the implant.  I prefer high profile silicone  implants in order to maintain some upper pole fullness.  The third is redraping of the skin by performing a complete breast lift or formal mastopexy.  The patient’s after photos are approximately eight weeks out.  There is still some pinkness to the scars.  On examination, the upper poles appear to be symmetric and soft.  The implants have been lower to appropriate level.  The nipple positions are equal and are found more concentric within the center of the breast rather than at the bottom of the breast.  The scar tissue has been released and removed.  The patient no longer has pain in her breast and it is soft.  She has excellent symmetry, softness to touch and a normal appearance to her breasts at this time.

 

After Photo

After Photo

Double bubble breast deformity surgeries are difficult to reconstruct.  Releasing the parasternal attachments of the pectoralis major and often the lateral attachments of the muscle must be performed on a secondary operation in order to lower the implant to the correct position.  A very aggressive capsulectomy is performed which will release the scar tissue into the axillary region and down to the inframammary fold.  Finally, a complete breast lift is required, not a periareolar nor vertical, but actually a complete formal mastopexy is used often in order to recreate a normal shape to the breast as can be seen in the patient’s after photograph.

SEROMA FORMATION AFTER TUMMY TUCK

Jackson-Pratt Drain

Jackson-Pratt Drain

Patients after tummy tuck (abdominoplasty) procedure may present with multiple complications, one of which is a seroma.  Seroma is a complication that may occur in up to 1 to 2 percent of abdominoplasties, especially large paniculectomies.  In my opinion, in order to reduce this risk complication, it is important to drain the abdominal cavity.  In the majority of tummy tucks (abdominoplasties) I use 10 mm Jackson-Pratt drains; however, with large paniculectomies at least three drains will be place, one on each hip and one in the suprapubic region.  Removing the drain is easy and usually is performed at the office setting between postop day 7 and day 10, depending upon the amount of drainage fluid.  Normally, I wait until there is less than 24 cc of drainage fluid in a 24-hour period before removing the drain and usually not less than 7 days after the initial surgery. Seroma formation is associated with fluid that forms in an open abdominal space.  This can occur anywhere in the body where there is an open space that has been created surgically, including a breast pocket.  For example, when implants are removed, the pocket may create a seroma and therefore a drain should be placed as well.  Seromas are the serous fluid that the body creates within the cavity.  These can be painful on examination.  The serous fluid can find its way out either through the incision or it can be resorbed back through the body.  Small seromas are actually quite common and resorb within the body and are uneventful.  Large seroma, however, may be painful and expanding along the lower abdominal wall and require aspiration and/or secondary trips to the operating room with drainage tube placement.

In my practice, I have seen very few seromas in that we do using the drainage tubes for 7 to 10 days as well as we are very thorough on our hemostasis along the abdominal wall.  Opening of just enough tissue up to the subcostal margins in order to allow for the abdominal flap to be lowered and removed is important.  Excessive dissection above the subcostal margin or the ribcage can lead to increased seroma formation.  Lymphatics can also be disturbed in the inguinal area (the groin crease area) which could lead to lymphatic fluid formation and seromas.  Therefore, care should be taken on dissection along the inguinal area and along the groin region and suprapubic region toward the femoral area.  Seromas can be identified either clinically if large, a manual wave can be identified on clinical examination by palpation of the abdomen and if not certain, an ultrasound can be performed in order to determine specifically where the loculation of fluid collection is for aspiration either directly or through ultrasonic aspiration.

Dr. Stuart A. Linder Joins the Exclusive Haute MD Network

On April 16, 2013 I was excited to see a press release on PRWEB regarding my joining of Haute MD Network. Haute MD Network is comprised of the most prestigious doctors in various fields across the US. Members are revered for their skill in one of nine specialties: Breast, Face, Smile, Nose, Skin, Body, Orthopedic, Hair Restoration and Vision/Lasik. The Haute MD blog is a one-stop source for ground-breaking news, trends and events in the industry.

Saline Breast Implant Valve Leakage

Ruptured Breast Implant

The patient in the video below presents a valve leakage from her 14 year old McGhan 240 saline filled breast implant. Upon removal of the implant Dr. Stuart Linder identifies the cause coming from the breast implant valve. It appears that the valve leakage caused roughly 85% of the saline volume loss.

Entertainment Tonight "Young Hollywood Plastic Surgery"

Dr. Linder consults for Entertainment Tonight to discuss “Young Hollywood Plastic Surgery”. The show will be on Entertainment Tonight April 11th, 2013.

Ruptured Implant Removal

The patient in the video below presents a ruptured implant.

In the operating room it can be seen that the patient’s implant came out quite smoothly and is a smooth low profile by Mentor.

The implant upon removal from the video is yellow in appearance, indicating a chronic rupture.

STYLE 15 NATRELLE MODERATE PROFILE

SILICONE GEL IMPLANT, A NATURAL LOOK
Untitled-drawing-2-1The patient  presents with bilateral breast dysphoria, loss of upper pole fullness of her upper breast, excellent candidate.  Patient will do well with a style 15 silicone gel placed in the dual plane technique through a periareolar approach.  Her preoperative photos show loss of upper pole fullness of her breast.  Patient desires lateral fullness with increased upper pole rounding.  As a result, 397 cc smooth Natrelle silicone gel implant was placed in the dual plane.  Postoperative photograph from the frontal view show excellent positioning with well-healed scars along the periareolar and excellent symmetry.  The moderate plus silicone gel from Natrelle is an excellent option for a natural breast with increased upper pole fullness.

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