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Dr. Linder's Blog


Monthly Archives: September 2016

Approval Of Allergen’s New Natrelle Inspira Extra Cohesive Breast Implant

Allergan Announces FDA Approval

Allergan Pharmaceuticals continues to make great stride in increased enhancement of their already excellent technology with silicone and saline breast implants.  Currently, on September 23, 2016, the FDA has now once again approved their newest silicone gel implant, the Inspira Natrelle Extra Cohesive Silicone Gel Implant.  This implant has increased gel cohesiveness with a round implant with an extra high gel fill ratio.

This is especially useful in my practice as a specialist in breast reconstruction revision surgery.  Patients present with thin tissue after multiple reconstruction revision and having this extra cohesive silicone gel smooth implant will greatly reduce the need for ADM graft material and reduce visibility in revision patients.  The cohesive breast implants offer women both reconstruction augmentation or revision surgery options with a combined high gel-fill ratio for customized results.  This new implant allows patients to get the same high gel-fill ratio and fullness offered by Natrelle Inspira lines of implants with their most highly cohesive foam silicone gel.  The FDA has now approved this with both smooth and bio-filled textured surfaces in the round shape implants.  The smooth version of Natrelle Inspira round gel filled breast implants was approved by the FDA back in February 2015.

This silicone gel implant is considered one of the finest implants ever created.  We are very much looking forward to using the new Inspira SRX and SRF Extra Cohesive Gel Implants by Allergan Pharmaceuticals.

6 Months After Breast Augmentation

Six months after performing a primary breast augmentation surgery for a 50 year old female Latina, it was great to hear her express how happy she is with her surgery. She had come into my office looking to increase her size, shape and cleavage.

To achieve her expectation I selected 320 cc high profile saline breast implants and filled the right breast to 350 cc and 360 cc to the left breast. The incision for the augmentation was performed under the areola and the implants where placed behind the muscle, to reduce the risk of scar tissue capsular contracture and palpability of the implant.

The post op photo to the left is six months out and she has a excellent look and balance.

I had the privilege to see the patient at eight months post op and as you can see by the photo below she is doing very well.

8 Months Post Op

8 Months Post Op

For more information regarding breast augmentation or to set up a consultation call us a 310-275-4513 or fill out our online contact form.



The effects on the nipple from breast augmentationbreast revisionbreast lift and breast reduction can be significant. They can include loss or gain of increased sensitivity to the nipple areolar complex. The nerve supply is the 4th lateral intercostal nerve that supplies the nipple areolar complex coming from the side of the chest around the muscle, the peck major, and underneath the nipple. If this is damaged, you could have obvious complete loss of the nipple sensitivity.

Sensitivity is associated with preservation of that nerve. This nerve can be stretched with neurapraxia or cut completely or blunt traumatically torn during lateral dissection of a breast augmentation procedure with either saline or silicone implants.


The loss of sensitivity ranges throughout the United States somewhere between 4 and 5 percent, by reports, for breast augmentation. The number greatly increases with breast lifts and breast reductions which can reach up to 10 to 14 percent. Hypersensitivity can also occur to the nipple areolar complex with new neuronal regrowth of nerves underneath the periareolar incision which could lead to hypersensitivity.

In general, after eight weeks usually the sensitivity returns to a normal state as baseline preoperative. However, it can take 12 to 18 months for complete sensitivity to return or at least partial. Breastfeeding can also be lost with all three procedures and again similarly the numbers increase as you go from breast augmentation to breast reduction.

Any patients who will undergo a breast implant, breast lift or breast reduction, must be cognizant of the fact that they may certainly lose sensitivity and/or the ability to breast feed or lactate. Certainly, the technical skill of the surgeon being Board Certified with the American Board of Plastic Surgery should reduce the incidence of these deleterious effects.

Body Makeover After Weight Loss

body contouring

I evaluated a female who was looking to have a body makeover. During the consultation, she stated she wanted to have her abdomen enhanced, her hips shaped, and a breast augmentation. She explained that after having weight loss, her goal was to get her shape back to where it was in her younger days.

After setting her expectations, we decided to perform an abdominoplasty or tummy tuck along with liposuction of the hips area and a breast augmentation.  For the breast augmentation, I placed 425 cc high-profile silicone breast implants and positioned them in a subglandular position. Subglandular means the implant is placed in a pocket behind the breast gland, entirely on top of the pectoralis major muscle.

As you can see, after only eight weeks post op, the abdomen, hips, and  breasts look fantastic, and she is very pleased with her recovery.

To schedule a consultation with Dr. Linder or for more information on body contouring, call us at 310-275-4513 or contact us by email.

High Profile Saline Primary Augmentation

The patient to the left is a 24-year-old female requesting a breast augmentation. As you can see by the preop photo, both breasts were already nicely balanced.  The patient was looking to increase her size and fullness overall. After she had explained her expectation, we selected 325 cc high profile saline breast implants for her primary augmentation.
The postop photo is six weeks out, and she is happy with the size and AP projection.
For more information regarding breast augmentation surgery or a consultation with Dr. Linder, give us a call at (310) 275-4513 or feel free to contact us via email.





The preoperative photos indicate the patient has undergone two previous breast augmentations. The patient has severe Pectus Carinatum deformity of her right breast, greater than the left. She has severe pectus carinatum of the entire right lateral chest cavity, sloping laterally and posteriorly. This causes lateral displacement of the implant. There is visibility of the implant as well as a pin cushioning along the right medial breast bone or sternum. Notice the implant edge which was causing severe irritation of the sub-dermis. This patient will require Pectus Carinatum surgery via breast reconstruction. She used 600 cc style 45 extra high profile Natrelle Allergan silicone implants with a right medial open capsulotomy, meticulously releasing the capsule along the inferior parasternal ridge as well as releasing the right medial muscle. Her postoperative photograph shows six weeks postoperative status post medial open capsulotomy, inferior capsulectomy of the right breast, superior bilateral open capsulotomy and removal of the low profile 450 cc implant with replacement with 600 cc style 45 silicone gel implants as well as a right areolar reduction in order to regain symmetry with the left side.



The patient has done extraordinarily well. The patient has used compression Dr. Linder Bra for six weeks postoperative in order to maintain the medial breast pocket shape. This is extraordinarily difficult surgery. Only breast revision specialists who perform augmentation mammoplasties and breast reconstructions who are Board Certified with the American Board of Plastic Surgery should be performing difficult surgery and revision breast surgeries such as the above example. The extra high profile gel reduced visibility and rippling due to its round shape and increased AP projection with decreased lateral width.


Tissue Capsule Around Breast Implants


Any type of breast implant that is placed in the body reacts by forming a protective lining around the implant. This protective lining is referred to as the capsule. Often this capsule is also know as tissue capsule or scar capsule, although it is not exactly the same as scar tissue. The capsule if formed by your own living tissue and happens regardless of whether the implant is silicone, saline, smooth or textured.

In some women, the capsule has a tendency to shrink or squeeze the implant which is referred to as capsular contracture. The tighter the capsule becomes the firmer the breast feels and may become distorted in shape.

The pre-op photo shows that the patients left breast is having a distorted shape due to capsular contracture. As you can see the breast is shrinking and becoming firmer than the the right side. During the surgery I removed the tissue capsule around the 2 year old implant and was able to position the implant to match the right breast.

For more information regarding capsular contracture or to schedule a consultation with Dr. Linder call 310-275-4513 or contact us via email.