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Dr. Linder's Blog


Monthly Archives: October 2013

ET Uncovers The Back To Work MakeOver

October 24, 2013


Brooke Anderson from Entertainment Tonight uncovers extreme back to work makeover for a aspiring actress Andrea Santean.

I was happy to see how beautiful Andrea was during the unveiling at Jose Eber Salon in Beverly Hills on Thursday night.

I want to thank not only Jose Eber but also Dr. Kristi Funk and Dr. Jason Diamond for their wonderful support and skills regarding Andrea.








bioCorneum Helps Reduce Scarring

I have used bioCorneum for several years and  the product is a silicone fluid liquid with an SPF30 sun block.  The bioCorneum works over several months to greatly reduce scarring and also reducing the effects of keloid formation as well as hypertrophic scarring.  There is a significant measure of improvement in the scar appearance over time.

On the bioCorneum new website, you can mark your scar, determine the redness pigmentation and elevations scores that will help track the healing. I find this site to be very informative.



Hematoma is a one to two percent incident status post all major surgeries under general anesthesia. Drainage tubes are placed postoperatively for a minimum of 24 hours in our practice which may help to evacuate the fluid. However, drains have not been found to prevent hematomas. Patients should refrain from aspirin, Advil, Motrin, Excedrin or nonsteroidal anti-inflammatory medications for 10 to 14 days prior to surgery to reduce incidents of hematoma formation.


Avascular necrosis or skin loss can occur in patients who have breast reduction surgeries, especially if the blood supply is poor and flaps are thinned out too much.


Dehiscence or wound separation can occur in patients when the tension is too tight and the incisions are closed with undue tension. Loss of the nipple areolar complex due to ischemia or avascular necrosis can occur if the blood supply is sacrificed and the pedicle is not thick enough with enough blood supply to maintain it.


Erythema and cellulitis are skin infections superficial to the skin, which must be treated aggressively with either oral or IV antibiotics.


Later complications can include breast asymmetry, scarring which can include keloids, hypertrophic scarring, wide-spread scarring, hyperpigmentation, hypopigmentation, fat necrosis, skin contour irregularities, mal-shaping of the breast, asymmetry of the nipple areolar complexes, over-removal or under-removal of breast tissue.

Chronic Seroma – Breast Diagnosis and Treatment Options

Patients in my practice present with both acute and chronic seromas status post blunt trauma to the chest after a breast augmentation procedure.  The seroma is simply a water serous fluid that the body creates after a tear in the capsule.  Capsular tear may lead to this fluid accumulation which can differ in size, between medium and small seromas.  Small seromas may resolve with a few weeks over time.  Moderate to large seromas may however settle for several months and may require surgical intervention with exploration of the breast, evacuation of the seroma, antibiotic irrigation and possible JP drain placement, if necessary, due to inflammation of the pocket.  Seromas can be found in any pocket, including breast augmentation, subpectoral or subglandular pockets, or an abdominoplasty cavity in which there is extensive dissection over the abdominal muscles leading to a large free space that can be filled with fluid.  The diagnosis of a seroma is normally associated with an enlargement of the breast with fluid shifts within the breast itself.  It can be diagnosed either clinically for large and medium size seromas or can be determined by ultrasound for smaller seromas.  Seromas should be differentiated from hematomas which are often associated with ecchymosis and staining from hemosiderin deposition of the skin over time.  The diagnosis of a seroma is also consistent with blunt trauma, including motor vehicle accidents or whiplash accidents from a seatbelt which leads to a tear of the capsule and serous fluid formation.  Seromas that are not drained, over time may lead to capsular contracture with resorption of the serous fluid back into the capsule causing thickening, hardening and scar tissue formation.  The treatment options for small seromas can include conservative management, ice compression, antibiotics, aspiration and compression garments, including the Dr. Linder Bra.  Medium to large seromas should undergo, under general, exploration with possible drain placement if necessary.

The video provided shows a patient status post motor vehicle accident with a 700 cc clear straw-colored seroma that was found under exploration of her breast under general anesthesia.  Notably, she had scar tissue contracture along the medial breast requiring open periprosthetic capsulectomy.  Implant was replaced after copious irrigation with antibiotic irrigant, including gentamicin and Bacitracin and a 7 mm JP drain was placed in order to reduce recurrence of serous fluid.  It is controversial when not to place a Jackson-Pratt drain.  Patients who have small seromas that do not show any further evidence of fluid accumulation or acute inflammation or bleeding do not always need a drain.  Do remember that drains can be a portal for infection, staph, strep, MRSA, E-coli, pseudomonas and other types of bacterium, especially when a prosthetic device such as an implant is found within the breast cavity.  Therefore, it is important to weight the risk of a drain with the risk of recurrence of fluid if there is active inflammation.

In this patient specifically due to the scar tissue contracture and acute inflammatory response, JP drains were subsequently placed in the pockets.  Seromas are very commonly associated with trauma.  Trauma can be as simple as lying on her chest, lying on your side at night during sleep or a heavy workout with a tear in the capsule.  It can also be associated with severe blunt trauma, including assault or a motor vehicle accident with seatbelt whiplash.

Board Certified Plastic and Reconstructive Surgeons are able to diagnose and treat these seromas accordingly.

Top 10 Boob Job Myths

  • Breast Implants Can Cause Cancer
  • False: No studies or experimental data have ever been able to link breast implants with cancer.
  • Breast Implants Must be Removed Every 10 Years
  • False: There is no specific data on duration of time for implant replacement. The implants may last a lifetime or only a few years depending on complications, including deflation, scar tissue formation or choice to change the size of the implants.
  • I Should Never Wear an Underwire Bra with Implants
  • False: Underwire bras can and should be worn, but only once all healing has occurred. Over time, without proper support the weight of the implants can create significant sagginess and stretching of the breast tissue and skin.
  • Shaped Implants are More Natural than Round Implants
  • False: Imaging studies of the chest have shown that both shaped (anatomical) and round implants appear to have a similar natural slope when properly placed under the muscle. One complication that can occur with shaped implants is rotation of the bag, which can lead to disfigurement.
  • Loss of Sensitivity of the Nipple is Associated Only with the Periareolar Approach
  • False: Numbness can occur from any approach if the nerves are stretched or traumatized during surgery.
  • Mammograms are Not Possible with Implants
  • False: Placement of the implants, either Silicone or Saline under the muscle will help with Displacement Technique Mammography and allows for excellent sensitivity results.
  • Women Over the Age of 50 Should Not Undergo Breast Augmentation
  • False: Patients of any age may undergo the implant surgery as long as they are healthy, in good medical condition and free of breast cancer. Lab work is required for all surgery candidates, and a routine mammogram is required for anyone over the age of 35 or with a family history of breast cancer.
  • Mammograms are Not Possible with Implants
  • False: Placement of the implants, either Silicone or Saline under the muscle will help with Displacement Technique Mammography and allows for excellent sensitivity results.
  • The Most Common Reason for Reopening the Incision is the Patient’s Desire to Remove the Implant Entirely
  • False: Actually deflation, 18% and Capsular Contracture, also 18% are the #1 reasons for reopening, or undergoing a second procedure.
  • More Women Desire to Go Larger on the Next Surgery and Believe That They Went Too Small Originally
  • True: Women become accustomed to the swelling that generally occurs during the first 2 – 3 months after surgery, when that subsides they miss the fuller feeling and desire to have slightly larger implants put in to compensate for the loss of the swelling.

Breast Revision Transition, Low to High Profile

The patient below presents with a significant amount of skin laxity with her low profile implants which she desires to have replaced for upper pole fullness and narrowing of the lateral breast.  The patient presents with breast dysphoria due to the flattening appearance of her low profile saline implants placed by a different surgeon through the inframammary approach.  Patient will do well with removal and replacement with direct high profile smooth saline implants which were actually slightly narrower in her chest, but gave her significantly more upper pole fullness as well as lift without any excessive scarring.  The patient on postoperative Day 14 is shown.  There is decreased skin laxity, fullness is excellent and the patient is shown in a Dr. Linder white bra.  The upper pole fullness is greatly enhanced and the patient has less lateral fullness and disturbance with fullness of the breast and the breast upper arm inner section.

High profile saline are an excellent alternative for patients who desire upper pole fullness that have had lower profile bags desiring both increased projection and less lateral display or fullness.


Breast Revision, Malposition and Double Fold Reconstruction

The patient presents with severe breast deformity with a double inframammary fold due to inadequate release of the parasternal attachments of the pectoralis major muscle as well as bottoming out of her bilateral breast.  Her reconstruction required bilateral open periprosthetic capsulectomy, circumferential open capsulotomy, removal and replacement with high profile saline implants and release of the upper pole of her breast pockets.  The inferior capsular sling was absolutely essential in bringing the nipple areolar complexes more to the midline and recentralizing it as well as to reduce the bottoming out and elevating the inframammary fold.  The secondary fold was released superiorly by releasing the parasternal pectoralis muscle attachment and a radial striated open superficial capsulotomy internally.

Her postop results are at six weeks.  The only incision is to the inframammary of which she has, I believe, an excellent result with repositioning of the nipple areolar complexes centrally by simple internal inferior capsulorraphy and inferior capsular sling.  This patient presented with multiple deformities which included the double fold, capsular contracture and lateral position of the implant and bottoming out, all which were reconstructed through solely and inframammary approach.