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Dr. Linder's Blog


Monthly Archives: August 2014




This patient is an 18-year-old female presenting with severe skin laxity after losing approximately 25 pounds. Notice the patient has what is referred to as “grade 3 skin laxity, grade 3 ptosis.” The nipples are well over 8 cm below the fold. Anything below 3 cm below the inframammary fold is considered grade 3 ptosis. She has ample breast tissue volume and there is an excellent candidate for a straight breast lift without the use of an implant. Herpostoperative results show three-week after surgical healing. Notice the positions of the nipple areolar complex are both at approximately 5 cm from the bottom of the 6 o’clock nipple areolar complex to the inframammary fold and are symmetric. The right breast was slightly wider laterally preoperatively which is why you can still see a little bit of lateral fullness on the right side. In any case, she is feeling well and symmetry is excellent.


Patient’s in their later teenage years who have very severe skin laxity may be excellent candidates for breast lifts using the Wise-pattern inferior pedicle formal breast lift. The side view shows complete loss of upper pole fullness of her breast with flattening of the left breast, complete upper pole involutional atrophy. Because of her age, she declined at this time to have an implant rather than a straight formal lift which now on her postoperative lateral view it shows the nipplespointing straight out with complete loss of skin along the fold. This is a typical result for a breast lift mastopexy. Often patients in their teenage years should consider waiting to undergocosmetic surgery of the breast. In this case, however, with this degree of severe skin laxity as well as the emotional physiological and psychological negativity to her chest, she was an excellent candidate and has an excellent result.


Screen Shot 2014-08-19 at 10.17.13 AMThis is an excellent case example of a patient that presents with significant skin laxity of the left breast greater than the right. She also has asymmetry with the left breast significantly larger than the right. The patient declined to have any form of significant scars on the breast mound itself except for under the nipple. The operation that I performed included bilateral saline augmentation mammoplasty using high profile saline implants through the dual plane as well as a removal of inferior breast tissue which allowed tightening of the lower pole of the left breast without a vertical scar.

Her postoperative result shows nice symmetry with good cleavage, a decrease in the pectus excavatum that is notable preoperatively, the upper pole shows great fullness and the nipple on the left has come up significantly, although it is not quite as high as the right side. This is an excellent example of asymmetry with skin laxity in which the patient can achieve a reasonable good result using high profile saline implants in a limited pocket without a breast lift.



This is a case study with a patient that I personally performed a breast augmentation 15 years ago on. She has developed a right ruptured implant and some bottoming out over the last15 years. At the time, only low profile implants were available. Low profile 390 cc saline implants were used. Scar tissue was also found in the upper pole of the breast causing inferior displacement of the implants.

The patient desired fuller breasts in order to regain upper polefullness and decrease lateral width. A high profile saline exchange was performed. Notice the postoperative day one result. This shows upper pole fullness, excellent cleavage, and there is no further widening of the bag; however, the nipple areolar complexes are now situated centrally in the breast and the bottoming out has been completely corrected without any form of inferior capsulorraphy or any skin excision. Simple reducing the low profile flat to a high profile saline, opening up the superior capsule through the inframammary approach, has allowed for an excellent result of centralization of the nipple areolar complex and complete abolishment of the bottoming out.



We perform breast augmentations weekly.  Both saline and silicone gel implants are used in our Beverly Hills Surgery Center.  Interestingly, this is a case example of a silicone gel implant bleed.

The patient underwent augmentation mammoplasty with silicone textured implants under the muscle by a different surgery approximately 13 years ago.  Although the MRI does not show specific rupture of the implant and that the shell of the implant is intact, upon removal of the implant there is significant silicone gel bleed.  What that simply means is there are micro pores within the shell of the silicone implant that actually bleed small droplets of silicone.  Examination of the implant, as can be seen by the photographs, shows this light silicone layer external to the shell.  Upon pressing on it with your finger, a small amount of silicone appears to be cohesive and sticky and it appears there are small micro droplets throughout the shell.  Silicone gel bleed is the usual process of all silicone implants over time.  The silicone gel bleed does increase risk of capsular contracture, calcifications, hardening and scar tissue formation.  Silicone gel bleed over time can lead to both intra and extracapsular spread of the silicone, with spread furthermore to lymphatics, including the axillary lymph nodes.

The general message from this blog is that simply because your silicone implants do not show a specific rupture on MRI, does not mean there is not bleed and silicone leakage external to the implants.  As a result, I still believe that implants should be replaced every 10 to 15 years in order to reduce the silicone bleed and its consequences, including capsular contracture, calcification, calcified granulomas and scar tissue formation.

Chronic Rupture – Saline Breast Implant


This is an excellent case example of a patient who left her saline implant in her chest for over two years. For some reason she declined to have the implant replaced until now that it has become painful. This is an obvious rupture on clinica examination. Mammogram also showed scar tissue contracture with complete deflation of the left saline implant.

I recommend that these implants be replaced within four weeks after a rupture in order to reduce scar tissue contracture that will certainly occur.

In any case, the patient underwent surgery through a previous periareolar incision. The implant was removed. Scar tissue was then completely released and exenterated through an open capsulectomy, releasing scar tissue circumferentially around the pocket and the implant was then reconstructed using a style 68 high profile Natrelle 400 cc saline implant.

Patients with ruptured saline implants simply should have them replaced, no different than a blown out tire on a car, this needs to be replaced as soon as possible in order to reduce scar tissue which will make it more difficult to regain a symmetric appearance in the future.