Over the past few weeks I was asked by The Insider, ET Online and Livescience.com my thoughts regarding the recent photographs of actress Renee Zellweger at the Elle magazine’s Women in Hollywood awards. Below are the media links.
THE INSIDER WITH YAHOO
The Insider with Yahoo asks plastic surgeon Dr. Stuart Linder about celebrity
What Did Renee Zellweger Do to Her Face? Plastic Surgeon Weighs In
October 21, 2014
The Science Behind Renée Zellweger’s New Face
October 22, 2014
Gynecomastia is referred to as male breast reduction. It is associated with glandular tissue and fatty tissue found in the entire chest area. This extends from the infraclavicular, under the clavicle, along the parasternal to the inframammary fold and all the way laterally to the anterior axillary line. There are two different types of tissue that can be found in gynecomastia patients. They include glandular tissue and fibrofatty tissue. The fatty tissue can usually be sculpted around the chest area, while the gynecomastic tissue normally requires direct excision through a periareolar approach.
Our patients are normally placed under general anesthesia and an incision is made underneath the nipple areolar complex from approximately the 5:00 to 7:00 o’clock position. At this time infiltration of tumescent fluid with a Klein needle is performed and liposuctioning with a 3 mm triple lumen Mercedes cannula to 1 atmosphere of vacuum suction pressure is used to sculpt the chest area, again extending along the sternum to the infraclavicular at the anterior axillary line and down to the inframammary fold. A large wedge of tissue is then removed, usually it’s a wafer of tissue in the shape of a football, from the posterior retroareolar region. A platform of glandular tissue is however maintained with the undersurface of the nipple areolar complex to contour and depression deformities.
After removing this large wedge of tissue, it is taken down to the fascia overlying the pectoralis major muscle. Hemostasis is acquired using electrocautery. Deep closure is performed to close the dead space, 2-0 Vicryl sutures and the simple subdermal and simple subcuticular sutures to close the skin.
Patients present desiring implant removal without a breast lift. Certain patients are candidates for this operation where implants can be removed, drains placed for seven to 10 days without a full breast lift. This is an excellent example of a patient who has severe scar tissue with a Baker IV capsular contracture and a rupture of the left implant. From my experience and judgment, this patient will do well without a full breast lift and for her the scars would not be worth the tradeoff of a further tightening procedure.
Her preop photos show severe right breast hardening with a double-bubble deformity, scar tissue contracture with implant raised superiorly. The left breast shows ruptured implant. Patient has already had a periareolar lift by a previous surgeon. In any case, the implants were removed and drains were placed.
She was placed in a Dr. Linder Compressive Bra for six weeks. Notice, there is good position of the nipple areolar complex and there is contracture of the tissue with excellent position of the breast itself. This is an excellent example of explantation without a breast lift for a patient that desired implant removal after 14 years.
BREAST AUGMENTATION MASTOPEXY
This patient case example shows a patient with severe grade 3 skin laxity with loss of upper pole fullness of her breast. The patient desired full breast lift and reduction of the nipple areolar size. She underwent augmentation mammoplasty using high profile saline implants in the dual plane. The full mastopexy scar shows good healing around the nipple areolar complex vertically and along the inframammary folds. Notice the left nipple areolar complex was elevated approximately 1.2 cm higher because of increased skin laxity notable on that breast.
Patients with dark skin and increased melena certainly are an increased risk for hypo pigmentation, including African-American women. This is stressed to them in preoperative consultation. This patient is an excellent example of an augmentation mastopexy procedure that can be combined at the same time with excellent results. Furthermore, one-inch Steri-strips were used and two-week intervals for a total of six weeks to reduce spreading of the scars.
Recently, Joan Rivers passed after having an endoscopy and possible biopsy of vocal cord in an
outpatient ambulatory center in New York. I had the amazing opportunity to work with Joan
Rivers and Melissa on their show, Mother Knows Best, for the Woman Entertainment Network
over the last few years. I have known Joan Rivers for well over 25 years. She was an incredible
comedian for the rarest kind. She was a jewel that was one in a billion. She would say it as it
was, no holding back, and this is what made her so unique. Although Joan Rivers was a poster
girl for plastic surgery, she was also a great mother and humanitarian, giving much to the Jewish
Foundation as well as having a true heart of gold. We will miss Joan Rivers dearly. Rest In
MRI DIAGNOSTIC FINDING
This is a 54-year-old female presenting with increasing pain in the left breast, status post motor vehicle accident trauma. She presents with scar tissue contracture of left breast preoperatively as well as right inferior bottoming out. The MRI shows complete rupture of the left silicone gel implant with intra and extracapsular rupture. Her photographs show evidence intraoperatively of complete rupture of the silicone gel Mentor implant. Notice the loose silicone gel material. Postoperatively, the patient is now three weeks out. Sutures have been removed. Notice that we have reduced the size of her breasts using 500 cc high profile style 68 Natrelle saline implants. Her breasts are smaller. There has been some tightening affect, there is no further scar tissue contracture and all silicone gel implant material has been removed.
Patients who have a history of trauma to the breasts with silicone gel implants should undergo MRIs in order to determine the integrity of the shell of the implants as soon as possible. This patient had not only severe disfigurement after her trauma, but complete rupture of the gel implant.