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Dr. Linder's Blog


Category: Breast Augmentation

Severe Bottoming Out Repaired by Internal Capsulorraphy of the Inframammary Fold

severe bottomingThe patient presents with severe scar tissue contracture of the entire collapse of the upper pole of her right breast causing lowering of the implant with the implant approximately 1.25 inches lower on the right than the left. Not only are her implants too large for her body, the technical error by a previous surgeon caused inferior displacement of the implant due to inadequate release of the superior pectoralis major muscle. The pressure has caused constant inferior creep of the implant down over the last three years. The photograph with markings in place show that the 397 low profile style 15 gels will be replaced with 350 cc high profile saline implants narrower and smaller. The superior upper portion capsulectomy was performed rendering complete muscle release up to the clavicle was maintained in the right breast. At this time you can see the photograph showing the muscle attached down to the intercostal space causing complete collapse of the upper pole.

The next photograph shows lifting of the capsule along the inframammary fold which is then released from the inframammary fold of approximately 2.2 cm or one inch.

The next photograph shows the capsule is now being sutured up using strong sutures in order to recreate a sling-like effect bringing the implant up and reducing the bottoming out. The next photograph shows the entire capsule has been completely sutured upward and reattached using a capsulorraphy. Finally, the wound has been closed with large sutures reapproximating the edges and postoperatively she now has a double fixation of the inframammary fold with not only capsulorraphy sling, but also with the skin excision tightening the skin as well as repositioning the nipple areolar complex into its symmetric position to the left side.





325 cc Saline Breast Augmentation

breast augmentation 325 ccThe patient to the right is a 26-year-old female who was looking to enhance her breast size and shape. As you can see by the pre-op photo, both breast are small in size but nicely balanced.  During her consultation, she explained her desire to increase the fullness of her breast, but also wanted to look as natural as possible. After listening to her goals, we agreed to schedule a surgery date.

During her breast augmentation surgery, we selected 325 cc moderate plus saline implants. This style of implants are mid-range with a moderate width and moderate amount of projection. This implant is also excellent to use when one is looking for that natural appearance.

The post op photo is three months out she is very happy and she has a excellent look, very natural and balanced.

To schedule your consultation with Dr. Linder and learn more about breast augmentation surgery,  call our office at 310-275-4513 or fill out our online contact form today.


During consultation, questions often arise as to which implants will be best for the patient, silicone vs. saline. Although both implants are still available, FDA has still restricted the use of silicone gel implants to women who meet specific criteria.

In the United States, both Mentor and Inamed provide FDA approved silicone gel implants for women who meet the specific criteria. This specific inclusion criteria, according to mentor’s adjunct study, is that the patient be female, that the patient be willing to follow the study requirements and that the patient must have at least one or more of the specific indications, including 1) postmastectomy for cancer reconstruction; 2) a severe deformity which can include status post traumatic or a congenital deformity, including pectus carinatum excavatum tubular breast deformity or severe asymmetry such as in Poland syndrome, or finally breast ptosis, meaning sagginess to the breast which requires some form of mastopexy or breast lift. Final criteria can include replacement or revision from either reconstruction from breast or breast augmentation in which silicone gel implants were used previously.

There are exclusion criteria as well, which can be found on the Mentor Preoperative Patient History Record. These include the patient having any history at this time of an abscess or infection anywhere in the body. If the patient is pregnant or nursing, they are excluded from the study. If the patient has any symptoms of diagnoses of lupus or scleroderma, uncontrolled diabetes, tissue that is incapable of handling the silicone gel implant, including radiated tissue or psychological reasons.

If a patient meets any of the criteria as described above and the patient has a desire to either add silicone gel implants and/or continue with them after replacement, then the patient will need to fill out with the plastic surgeon the entire informed consent.


The informed consent will include specific details which will mark out the risks and complications associated with the surgery. These will include infection, hematoma or collection of blood, serous fluid collection (seroma), capsular contracture with scar tissue formation as well as anesthetic risks. Capsular contracture can occur with either silicone or saline and may require removal of the scar tissue, referred to as a capsulectomy, or release of the scar tissue (capsulotomy) in order to allow more volume space and room for the implant to move.

Silicone implants may deflate, rupture or leak and may require replacement. They may be more difficult to detect because although there is a rupture of the intracapsular shell, it may not be detected for many years. Mammograms and even ultrasound may not detect the rupture and an MRI may be required in order to get a more definitive answer. Extracapsular silicone migration can occur as well as this may lead to free silicone which migrates to the lymph nodes under the armpit or the axillary lymph nodes or into other parts of the body. If an implant is ruptured, it should be removed as soon as possible. Increased scar tissue formation certainly may occur as well as migration of the silicone gel to different parts of the body.

Other complications associated with silicone gel implants, include silicone gel bleed. This is simply the oil of the silicone migrating through small micro pores within the shell, which may bleed through and be trapped within the scar tissue around the implant. This may increase calcifications. Mammography interference and difficulty in detecting calcifications versus cancer may also be associated with silicone gel implants, especially when placed in the retromammary pocket (above the pectoralis major muscle).

In contrast, saline implants may be more user friendly in that 1) we’re able to change the fill volumes of these implants with women who have asymmetric breasts are able to titrate the volumes of the implants to even out the breasts to make them more symmetric. Saline implants also if they shall rupture are an all or none phenomenon and within several weeks it will be quite apparent that the implant is deflated. The fluid from a saline implant when placed preoperatively in a sterile environment will be absorbed or resorbed and should yield no harmful effects to the patient.

Capsular contracture certainly can occur with saline implants, although in my practice I have found it to be less likely than silicone gel, as there is no silicone gel bleed with saline implants.

In the future, silicone gel implants may be available to the general public. At this time, it is still under FDA review and although the advisor panels have approved the silicone gel implants to be reviewed by the FDA, there is no definitive answer at this time. In general, as in any surgery, the use of silicone versus saline implants must be tailored to the needs and specifics of each individual. It is important to choose the specific implant carefully. The patient once again needs to be included within the criteria outlined by Mentor and/or Inamed Corporation in the United States of America.

Tubular Breast With Augmentation

before and after tubular breast augmentation

I was presented with a female patient who requested breast augmentation surgery along with correcting what she called her “constricted breast.” During her examination, I found that she had a condition called tubular breast deformity. Tuberous breasts or tubular breasts are a result of a congenital abnormality. After listening to her goals, we agreed to her expectation and scheduled her surgery date.
During her surgery, I released and removed the constricted breast tissue. I selected the moderate plus saline implants for its wide base and the least amount of anterior/posterior projection.  I used 360 cc implants and overfilled the left to 410 cc and the right to 400 cc to achieve a nice balance.
The photo on the right is eight months post-surgery, and she is very happy with the shape and fullness of her breasts.

To schedule your consultation with Dr. Linder or learn more about breast augmentation surgery, call our office at 310-275-4513 or fill out our online contact form today.




Breast Revision With Lift

breast revision

Pre-Op & Post-Op 2-Weeks

The patient presented is 28 years old and was looking to revise a previous breast augmentation. During her examination, I could see that her right breast had a downward elevation of the nipple-areola and a lower inframammary fold due to bottoming out. The left breast had scar tissue, also known as capsular contracture, which had formed around the implant. After listening to her expectations and agreeing on her goals to regain her breast appearance, we scheduled a surgery date.

During her surgery, I removed the old implants, repaired the breast pockets, and placed 425 cc saline high profile breast implants. I overfilled the 425 cc to 500 cc in both implants to create fullness and performed a Benelli Lift technique to raise the nipple slightly on the right side.

As you can see by the patient photo to the right, she is now four weeks post-surgery, and she has balanced symmetry and nice volume in both breasts.

after photo breast revision

Post-Op Photo 4-Weeks

To schedule your consultation with Dr. Linder and to learn more about breast revision or breast lift, contact us by calling our Beverly Hills office (310) 275-4513 or by filling out our online contact form.


Breast Augmentation With Benelli Lift

primary augmentation

The female patient presented is 26 years old and was looking to improve her breast appearance by increasing her breast volume and position. However, her thoughts about having a breast lift were concerning because of the potential scarring. During her examination, she showed a mild degree of breast sagging, and based on her expectations, a lift would be needed. After examining and listening to her goals, we agreed to schedule a primary augmentation and lift.

During her surgery, I placed 400 cc saline high profile breast implants. I overfilled the right implant to 440 cc and the left side to 455 cc to create fullness and symmetry. Because the implant alone would not elevate the breast enough and knowing her concern about scarring, I performed an incision type called the Benelli Lift to raise the nipples slightly.

As you can see, the patient is only four weeks post-surgery, but she has nice volume and symmetry, and she has a more youthful appearance.

To schedule your consultation with Dr. Linder and learn more about breast augmentation or breast lift call our office at (310) 275-4513 in Beverly Hills or fill out our online contact form today.


Body Contouring After Weight Loss

Body Contouring After Weight Loss

I evaluated a 28-year-old female that was wanting to have a breast enhancement as well as address her stomach area concerns. After losing over 120 pounds, her breasts were deflated, and her abdomen had excess loose skin. After her examination and listening to her goals, we agreed on the expectation and scheduled her for surgery.

During her surgery, I performed a breast augmentation using high-profile 350 cc saline breast implants along with a formal mastopexy (breast lift). Regarding the stomach area, I performed an abdominoplasty (tummy tuck) to remove and tighten the skin. Performing these procedures after massive weight loss is very gratifying, especially when someone is only 28 years old.

The post-op photo is three months out, and her transformation is well on its way. She is extremely excited about her appearance and looks forward to this summer.

To schedule your consultation with Dr. Linder or learn more about body contouring or breast surgery, call our office at 310-275-4513 or fill out our online contact form today.






Breast Augmentation After Two Years

I evaluated an African American female wanting to have a breast augmentation. During her consultation and examination, she expressed her desire to regain her fullness and projection. After listening to her goals, we agreed to use Allergan 425cc high-profile saline breast implants for the primary augmentation.  During her surgery, I over filled the 425cc implants to 465cc to increase her anterior/posterior projection.

Her post-op photo is two years out, and she is extremely happy with her fullness, size, and cleavage when wearing certain types of clothing.

To schedule your consultation with Dr. Linder or learn more about primary breast augmentation surgery, call our office at 310-275-4513 or fill out our online contact form today.


Breast Augmentation For 30 Year-Old

The patient below is a 30-year-old female that came to me 5 months ago looking to improve her appearance of her breast. During her consultation she shared with me how she was seeking to enhance her shape and fullness. After listening to her expectations, we agreed to use 320 cc high-profile saline breast implant by Allergan.

During her augmentation surgery I created a nice tight pocket for the new implants and placed the 320 cc giving a nice increase anterior/posterior projection.

Below is the postop photos the middle one is showing only 7 days out and the one on the far right is now 5 months postop. She has followed the post op instructions and as you can see she is extremely happy with her new look.

For more information regarding primary 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.

breast augmentation before and after

SRX & SRF Breast Implants

Breast implants

A few months back, my dear friend and colleague Dr. Robert Kotler came by my office and asked if I would discuss these new breast implants he has been hearing about by Allergan. During the video, I discuss the Natrelle INSPIRA® breast implants that I have been using for just about a year now.

The first implant I discuss is the SRX extra-full profile silicone implant, which has a smooth shell surface and provides patients with the fullest, roundest look. This silicone gel is excellent for women who do not have a lot of tissue because it reduces visible implant rippling and wrinkles.

The second implant I discuss is the SRF full-profile silicone implant designed to have increased durability with a smooth shell and full projection. This implant provides a significant amount of fullness in the upper pole of the breasts but has a slightly wider base than the SRX.

I truly enjoyed discussing this topic with Dr. Kotler, and I thought I would share his video from his YouTube channel.

To schedule a consultation with Dr. Linder and learn more about breast implant options, breast revision, or breast augmentation, call our office at (310) 275-4513 in Beverly Hills or fill out our online contact form today.