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Dr. Linder's Blog

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Monthly Archives: December 2015

Body Contouring of Abdomen and Breast

breast augmentation, lift and tummy tuck

Back in July, 2015 I was presented a patient looking to enhance her shape by lifting her breast and contouring the abdomen. During the consultation and examination we detected two weak spots in the abdominal wall, which she stated, she was having pain during certain activities or in certain positions.  We discussed her expectation and agreed that we would proceed with a  Breast Augmentation with lift, tummy tuck and repairing the two hernias.

For the procedure we had a general surgeon repair the hernias, and then I performed the abdominoplasty (tummy tuck)  along with a breast lift and 350cc saline breast implant filled to 370cc to her right breast and 350cc filled to 380cc to the left breast.

As you can see, after only six months post op, the patient is looking fantastic, and I’m very pleased with her recovery.

For more information regarding body contouring procedures, or to schedule a consultation, please call (310) 275-4513 or contact us via email.

Plastic Surgeons and Members of ASPS

asps-member-logo

A few weeks back, I addressed a question that I am often asked, which is what is required to be a board-certified plastic surgeon. I also mentioned during that blog post that there are 24 medical specialty boards recognized by the America Board of Medical Specialties (ABMS).  I know this can be confusing when trying to research online since many websites just state that their doctor or doctors are board certified but often don’t state of what specialty they are board certified.
To help confirm whether a doctor is board certified in plastic surgery, I would suggest that you also look to see if they are a member of the ASPS. ASPS is an acronym for the American Society of Plastic Surgeons and not only must these members be board certified by the American Board of Plastic Surgery (ABPS), but they must also meet the following rigorous standards:
  • Board certification by the ABPS or in Canada by The Royal College of Physicians and Surgeons of Canada®
  • Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
  • Pass comprehensive oral and written exams
  • Graduate from an accredited medical school
  • Complete continuing medical education, including patient safety each year
  • Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities
By choosing a member of the ASPS, you can be assured that you are choosing a qualified, highly trained plastic surgeon and not just one that performs cosmetic surgery.
I am proud to have been a member of the ASPS since 1999, and I encourage you to look for the ASPS Member Surgeon Symbol of Excellence (see photo) when making your choice for a plastic surgery procedure.
If you are interested in setting up a consultation or need more information regarding a plastic surgery procedure, give us a call at (310) 275-4513 or contact us via email.

Moderate Plus Saline Breast Implants

The patient below is 28 years old female, requesting a breast augmentation. The patient was looking for a very natural look to enhance and balance her overall shape. After she explained her expectation, we selected 390 cc saline moderate plus breast implants for the procedure. Moderate plus implants are the mid-range implants that have a moderate width and have a moderate amount of AP projection.

Below shows her pre op as well as 6 weeks post op photos.

For a consultation regarding breast augmentation surgery give us a call at (310) 275-4513 or feel free to contact us via email for more information.

breast augmentation 28 year old

Board Certified Plastic Surgeon Beverly Hills

America Board of Plastic SurgeryIn my Beverly Hills practice I am often asked what is required to be a Board Certified Plastic Surgeon. First of all I like to explain that there are 24 medical specialty boards recognized by the American Board of Medical Specialties.

In order to become a Board Certified Plastic Surgeon, the physician must first graduate from an accredited medical school, complete at least five years of additional training as a resident surgeon with a program accredited by the Accreditation Council for Medical Education or the Royal College of Physicians and Surgeons of Canada.  Therefore, it includes five years of residency training in all areas of surgery, two years devoted specifically to plastic and reconstructive surgery.

To be certified subsequently the doctor must specifically past both written and oral examinations after finishing a licensed plastic surgery fellowship.  To be a diplomate of the American Board of Plastic Surgery is a distinct honor and there is a time limits of 10 year periods of which rectification is required.

I am proud and honored to have been board-certified plastic and reconstructive surgeon for over 17 years and I hope when patients are making a decision on what surgeon to use for there procedure, that they look to ensure the physician is ABPS certified.

Pregnancy-Induced Capsular Contracture

Beverly Hills Plastic Surgeon,  Dr. Stuart LinderBreast revision surgery is extremely common in patients who have had implants placed in the past and have become pregnant and breastfed after pregnancy. The incidents of scar tissue surrounding the implants is extraordinarily high, and although a specific percentage is not indicated in the literature, in my practice, I see well over 50 to 65 percent of women who have given birth and breastfed to have an increased risk of Baker IV encapsulation. Baker IV encapsulation with scar tissue contracture is associated with a painful and physically hardened breast. Often there is tenderness, the implants are malpositioned, or they simply look distorted or funny in appearance. They also have pain with mild to moderate palpation and disfigurement. There seems to be an increase in scar tissue formation with breastfeeding even more than those who have simply delivered and have decided not to breastfeed. Whether or not to replace the saline or silicone implant with the revision surgery after pregnancy or breastfeeding-induced capsular contracture depends upon the duration the implants have been in place. Also, it depends upon the appearance of the implants intraoperatively.

In my practice, having placed well over 12,000 implants from thousands of breast revision reconstructive surgeries in Beverly Hills, it is notable that patients who have had implants for a shorter period of time (e.g., two or three years) may not necessarily have to remove their implants during the open capsulectomy and circumferential open capsulotomy procedure after pregnancy-induced scar tissue. I do each surgical patient on a case-to-case basis, depending upon what I find in the operating room. The implants may or may not need to be replaced. Implants over five years of age normally will be removed and replaced with the open capsulectomy. This is my general rule that has been successful over the last 17 years. In general, saline/silicone are replaced between 10 to 12 years postoperatively regardless of pregnancy- or breastfeeding-induced capsular contracture. Scar tissue is extremely prominent in women who have just delivered and especially those who have breastfed for an extended period of time. It appears that scar tissue contracture, which is associated with increased collagen formation as well as myofibroblast zones that are responsible for the contraction and the impingement upon the implant, increases during the lactation period of the post-pregnancy and delivery.

Capsular Contracture without replacing the implant

Capsulectomy without replacing Implants.

Again, patients who have had implants for the last couple of years may not necessarily need to replace the implants. This can be determined in the operating room by close inspection and integrity of the implants. The implants can be removed from the pocket, inspected, placed into an antibiotic irrigation, and then replaced back into the pocket. This, however, is something that is personal between the patient and the plastic surgeon. Pregnancy-induced capsular contracture can lead to a tremendous variation disfigurement of the breast. There is often significant hardness associated with the implants becoming malpositioned. Often they will rise superiorly upward towards the clavicle, and it can lead to a double-bubble deformity where the skin can over-drape the breast, and the nipple can be too low. This operation for double-bubble deformity would require an open capsulectomy, circumferential open capsulotomy, lowering the implant, replacement of the implant as necessary, and a full mastopexy often requiring an anchor scar or a Wise-pattern technique incision where skin is removed around the nipple areolar complex vertically and along the inframammary fold to reshape the breast. Pregnant women with implants should be expecting that there is a very significant chance that they will require breast revision surgery for open capsulectomy softening the pocket as well as possible replacement of the implant and breast lifts as necessary, depending upon how much breast growth has occurred during the pregnancy period and how much loss of tissue occurs after breastfeeding.
If you would like more information or to set up a consultation today, call us at 310-275-4517 or fill out our online contact form.

 

Capsulectomy Without Removal of Breast Implants

before and after Capsulectomy Without Removal of Breast ImplantsThe female patient presented is 35 years of age and requested to have a breast revision. During the examination, I confirmed that she had capsular contracture (scar tissue)  around the implants. Since the patient had her breast implants for fewer than two years, we agreed to perform a capsulectomy, which I removed the scar tissue around the implant and circumferential release, allowing the capsule more space and volume for the implant.

As you can see by the post op photo, she now has a nice natural look. I did not have to remove her breast implants to achieve the success of this surgery. Six weeks out, she is very pleased with her results.

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