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Dr. Linder's Blog

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Monthly Archives: April 2016

Breast Implant Removal, Followed By Augmentation

This patient came to me about 16 months ago with a ruptured silicone breast implant.  At that time we performed an explantation with an inframammary incision made and implants where explanted and removed.  During the surgery we addressed the scar tissue and the infected seroma. The pocket was irrigated with antibiotic irritant solution and 7 mm JP drain was placed throughout the inframammary incision. Drains where removed the next week and the patient was instructed to maintain wearing a compressive bra for the next 6 months in order to allow tightening.

The patient scheduled a consultation a few weeks ago where she expressed her desirer to have an breast augmentation. After discussing her expectation we decided to place SRX 400 cc gel breast implants and also perform a breast lift. After 12 weeks, the post-op photo shows a natural and symmetrical look, and most importantly she is happy. 

For more information regarding implant removal, breast revision or augmentation procedures, or to schedule a consultation, please call (310) 275-4513 or contact us via email

 

 

Breast Asymmetry Correction

Every week at my Beverly Hills practice, I see patients who have some variation of breast asymmetry. Breast asymmetry is defined as a difference of form, position, or volume of the breasts, and it affects more than half of all women. Slight differences in a woman’s breasts are generally of no concern; however, if the differences are greater than one bra cup size, they may cause some psychological distress, particularly during adolescence, when a young woman’s body and psyche are already changing so rapidly.

In the typical breast asymmetry patient, one breast will be larger with sagging, and the smaller breast will be tubular, conical in shape, and tighter. Most often, the smaller breast should have a saline implant placed with the dual plane technique and release of the parasternal attachments of the pectoralis major muscle and release of the inframammary fold as well as rounding out of the lower pole of the breast. Once this implant has been placed, the contralateral smaller implant can be placed in the dual plane location, and then a formal mastopexy can be performed to tighten sagging tissues and lift the breast. The patient will then be placed in a sitting position, and if further tailoring by breast reduction of the medial and lateral flap is necessary, this can be done meticulously and carefully in order to regain symmetry with the contralateral breast.

Below are the before and after photos of two patients who had their breast asymmetry corrected, and you can see the symmetrical results after surgery. I recommend that women be over the age of 18 years for this surgery. For more information or to set up a consultation, call us at 1-310-275-4513 or contact us via email.

Correction Of Severe Bottoming Out With Inferior Capsular Sling

Post Op Photo 4 Weeks Out

Post Op Photo 4 Weeks Out

The patient to the right presents with silicone gel implants placed submuscular; however, due to poor inframammary fold integrity, she ended up with dehiscence of the inframammary fold and inferior displacement of the implants causing severe bottoming out.  This can easily be corrected by inferior capsular sling in patients who have thick capsule and that is not of multiple revisions.

The patient specifically had a single operation with a formal mastopexy full breast lift anchor scar and silicone gel implants placed in the dual plane.  She had dissent of the implants due to thinning out of the tissue and had significant bottoming out which can be corrected with an inferior capsule sling and secondary inframammary skin excision with tightening down to the subdermis.  This patient underwent an inframammary fold release.  Capsule was then taken along the inframammary fold and resected from the chest wall above the periosteum of the ribs, elevated approximately 2.5 cm and resected of all redundant capsule; 2-0 Monocryl sutures were used to reapproximate the capsule lifting the inframammary fold approximately three-quarters of an inch.  The skin was then excised directly and the superior edges of the open wound skin were then sutured to the deep dermis which allowed secondary inframammary fold tightening.

Her postoperative results were at four weeks showing beautiful elevation of the inframammary fold.  No acellular dermal grafts were needed for this patient as she had ample thickened capsule which can be used to re-advance the fold and elevate it almost one inch.

Nipple Reduction and Breast Augmentation

The patient below is a 32-year-old Asian female that had significant nipple hypertrophy. This type of deformity is mostly encountered in the Asian population and, occasionally, in Caucasians. There is no “normal” female nipple, but it is usually roughly 1 cm in diameter with an almost equal amount of anterior projection. Along with her desire to reduce the size of her nipples, she also requested a breast augmentation. After listening to her expectations, we scheduled her surgery.
For the nipple reduction, I carefully went through a pedicle base, and for the augmentation, I used 240 cc SRF silicone implants. Her results two weeks postoperatively now show excellent symmetry to the nipple with some slight scarring healing around the periareolar incisions.
nipple reduction and breast augmentation

THE FACTS ON BREAST AUGMENTATION

Dr. Linder is a Board Certified Plastic Surgeon with the American Board of Plastic Surgery. He performs literally hundreds of breast augmentations year after year and has performed thousands of these surgeries over the last decade.

He is the author of his new book “The Beverly Hills Shape, The Truth About Plastic Surgery” along with numerous newsletters and magazines, including Skin Deep Magazine available at bookstores and news counters throughout the United States.

SILICONE VS. SALINE IMPLANTS

Silicone implants are now FDA-approved in patients over the age of 22 without any history of autoimmune diseases or cancer. Silicone breast implants have great advantages that are mostly associated with the natural appearance and softness and pliability of the breast. The implants are placed underneath the subpectoral plane and the dual plane technique, two-thirds under the muscle and one-third laterally over or along the edge of the pectoralis major muscle.

Silicone breast implants have little visibility and in thin women with ectomorphic build with minimal rounds of breast tissue, they are beautiful. They show less and feel more natural.

Breast Augmentation

BENEFITS OF SALINE IMPLANTS OVER SILICONE IMPLANTS

The biggest drawbacks for silicone breast implants are:

  • increased risk of calcification
  • hardening and scar tissue formation
  • difficulty in determining calcifications and possible malignancies

Thereby, the FDA requires that MRI’s should be performed every three years in order to identify any rupture of these silicone implants which can in a silent fashion.

Saline implants are still the goal standard and hallmark of typical patients. Saline implants are high profile implants which reduce the rippling by increasing the AP projection and reducing the diameter of the bag. The implants are fuller and less wide and therefore give a sexier, full appearance without being matronly and make the woman appear flatter and wider.

Breast Augmentation

Dr. Linder performs breast augmentation using the periareolar approach and the dual plane technique, whether it is silicone or saline. Saline implants usually will require mammograms with women of 35 years and older or every year over the age of 40. If a woman has a family history of breast cancer, she may require a mammogram and/or ultrasound be performed prior to the age of 35.

CONTACT US

In considering a doctor, it is extremely important that the patient seek a Board Certified Plastic Surgeon with the American Board of Plastic Surgery and also doctors who are members of the American Society of Plastic Surgeons.

This will give the patient the knowledge and comfort that their doctors are well-trained, experienced with the anatomy of the chest wall and has performed enough of these operations that they are safe and that the results are predictable.

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