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Category: Breast Reduction

Explantation & Breast Reduction With Lift

Pre-Op & Post-Op (day one)

Pre-Op & Post-Op (day one)

The female patient presented was looking to have her breast implants removed and wanting to improve her breast appearance without placing new implants. During her examination, she expressed she was hoping to have a breast lift and reduction. After discussing her expectations, we agreed to perform an explantation (implant removal), mammoplasty (reduction), and mastopexy (breast lift).

The video below shows the pre-op marking where I go over the implant removal, breast reduction, and a full breast lift (mastopexy)  using a wise pattern anchor approach.

During her surgery, I removed the high placed breast implants and performed a breast reduction (removing some tissue and skin to reshape and reduce the size of the breast) and a lift to bring the breasts to a higher and more youthful position.

The post-op (day one) photo shows a drain placed to help decompress the space around the pedicle that was created as well as wearing a Linder Bra to provide support after surgery.  The patient is happy, and she has achieved a nice shape and symmetrical balance.

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

 

Male Breast Reduction Procedure

gynecomastiaI was presented a 23 year-old male who was self-conscious about the size of his breasts. During the consultation and examination we discussed how to remove the excessive glandular breast tissue and fat by performing gynecomastia surgery. The procedure was performed under general anesthesia supervised by a board-certified anesthesiologist.

The photo to the right shows three weeks post-op, and as you can see the enlarged breast has been reduced and are well balanced. The patient is extremely happy with his appearance and will continue to follow my postoperative instruction for a few more weeks (light actives can be resumed – no heavy lifting).

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

 

 

 

Double H Breast Reduction Procedure

Pre-OP & 6-Month Post OP Photos

Pre-OP & 6-Month Post OP Photos

One of the most rewarding procedures that I perform in my Beverly Hills practice is Breast Reduction or Reduction Mammoplasty. This is a procedure to remove excess breast fat, glandular tissue, and skin to achieve a breast size that is in better proportion with a woman’s body. It also alleviates the discomfort associated with overly large breasts and allows women to feel better.

I evaluated a 52-year-old female a few months ago who had breast hypertrophy (enlargement of breast tissue) and desired to have a breast reduction. Like many women with overly large breasts, she was having neck, back, and shoulder pain and was unhappy with their appearance. After listening to her expectations and agreeing on our approach, we set a date for surgery.

During her breast reduction surgery, I removed well over 1,000 grams of breast tissue from each breast and performed a formal mastopexy using a wise-pattern technique. The frontal and oblique view of the post-op photo is six months out, and she has gone from a 42 HH to a 42 DD. She is extremely happy with the outcome and is so excited to be able to wear a size large sports bra.

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

 

 

 

 

Downsizing & Breast Reduction Surgery

I evaluated a 29-year-old female who, after a previous breast augmentation in Mexico, was looking to improve the appearance of her breasts. During her consultation and examination, she expressed that she was hoping to correct the asymmetry of her breasts and the size of her nipples as well as downsize their overall shape. After listening to her desires and agreeing on the expectation, we scheduled her for breast revision surgery.

During her surgery, I removed the breast implants from the previous surgery and discovered that they were CUI silicone implants, which are not available in the United States. After I removed the CUI implants, I performed a breast reduction (mammoplasty), nipple reduction (areola reduction), and breast augmentation using 350 cc high-profile saline implants.

As you can see from the four-week post-op photo, the revision surgery has achieved a nice symmetrical balance , well-defined cleavage, smaller nipples, and a slightly smaller overall size.

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

 

 

 

 

 

 

Areolar Reduction

 

Areolar Reduction Before and After PhotoPatients who undergo both formal mastopexies as well as breast reduction procedures usually will have a reduction in the areolar size. In general, areolas are made between 3.8 and 4.4 cm in size. I prefer to make them approximately 4.2 cm or 42 mm.

We have what are referred to as cookie cutter patterns in the three sizes, 38, 42, 44 to 46 mm. I use 4.2 cm cookie cutter patterns on both my breast lifts and breast reduction procedures in the majority of cases. The areolar reduction is considered a part of a breast reduction or breast lift procedure if the areolar is enlarged. Areola enlargement can be seen as large as 8 to 10 cm on large women’s breasts who undergo large reduction mammoplasties or women who have had significant stretching of the breast tissue after breast feeding or postpartum. As a result, the areolar reduction can be made with skin removed in a circumferential fashion around the areola.

Areolar Reduction Techniques

Different techniques can be performed, including the round block or Benelli technique, which is simply an areolar reduction with skin removed circumferentially as in a donut mastopexy. This, however, has significant problems with stretching of the scars, widespread scars and pin cushioning which can look very, very poor. Scarring, in other words, can be very poor with the Benelli lift. As a result, I prefer not to use this approach whenever possible. A vertical mastopexy can be performed where skin is removed along the vertical plane and around the areola which will reduce the tension around the nipple areolar complex, bringing it below the 6 o’clock position of the areolar down along the vertical or midline plane of the breast. This helps to dissipate tension from the areolar scar and the results I have found to be much better in general.

Finally, a formal mastopexy using the inferior pedicle Wise-pattern technique can be performed in an anchor scar-like fashion, where the skin is removed again around the areola vertically and along the inframammary fold. This greatly reduces scarring, stretching and tension along the nipple areolar complex and has led to beautiful scarring around the nipple areolar complex.

In our practice we use Kelo-cote once the sutures are removed, usually on day 14 to 17. The Kelo-cote silicone gel spray or cream can be used twice a day for three to six months which greatly reduces scarring, spreading, hyperpigmentation and telangiectasias and blood vessels within the scar.

Natural Breast Reduction

dr-linderWhat is a natural breast reduction? In my opinion, a natural breast reduction is breast reduction performed using native breast tissue, reducing the size of the breast by removing tissue centrally and along the medial and lateral aspects of the breast, repositioning the inferior pedicle without placement of an implant. In general, patients who desire to have combination breast reduction with augmentation will get more of a rounding shape to the upper pole of the breast and an excellent result as well. However, the more natural breast reduction is simply using native breast tissue.

A natural breast reduction in Dr. Linder’s practice is performed using the inferior pedicle Wise-pattern technique (Dr. Linder’s preferred technique). Tissue is removed from the superior portion of the inferior pedicle as well as from the medial and lateral aspects of the breasts. I like to remove more tissue laterally as well as liposuction the lateral breast to debulk the breast and narrow it while taking less tissue from the medial portion of the breast in order to increase cleavage and allow for a more natural parasternal angle.

Natural breast reduction surgery simply means using the natural tissue of the breast to recreate upper pole fullness. By keeping the inferior pedicle or the base of the pedicle bulky, 10 cm or more, we are able to allow for a more central increase fill volume of the breast by allowing more of the tissue that remains to be repositioned superiorly centrally which allows for almost the appearance of a breast enhancement without the use of an implant.

For more information regarding breast reduction or to set up a consultation with Dr. Linder  call us at 310-275-4513 or contact us by email.

Male breast reduction

Over the past year, I have seen an increase in the procedure gynecomastia. Gynecomastia surgery is a procedure to reduce enlarged male breasts. I believe the stigma for cosmetic surgery for men has disappeared, and men are excited to correct the size and shape of their breasts.

male breast reduction To the left is an example of a  25-year-old male patient that I performed gynecomastia surgery on about 3 months ago. The patient is very happy with the results, and his confidence is extremely high.

For men who feel self-conscious about their over  sized breasts, this procedure can help restore self-confidence and appearance. For more information, contact our office at 310-275-4513 or fill out our online contact form.

 

Reasons for Breast Reduction Surgery

Breast Reduction Beverly HIllsI am presented weekly in my Beverly Hills practice patients that are considering breast reduction surgery.  Most of these women are experiencing a range of physical issues due to overly large breasts, including:

Back Pain: when breast are excessively large, pulling forward on the woman’s body puts tension on her back muscles

Neck Pain: weight of the breasts affects a woman’s posture by pulling her shoulders and chest forward

Headaches: large breasts can lead to pain in the back of the head, known a occipital headaches

Rashes: skin folds of the breasts that rub together can cause a rash known as intertriginousdermatitis

Breast reduction surgery eliminates excess breast tissue and skin to reduce the size of the breasts and can alleviate many of these concerns. For a consultation regarding breast reduction surgery give us a call at (310) 275-4513

Breast Reduction Revision

Breast reduction revision is a very tricky operation because blood supply has already been violated once to the nipple areolar complex and therefore the Board Certified Plastic Surgeon must be very diligent and experienced with this technique. It is absolutely vital that the nipple areolar complex maintains its blood supply and that the base pedicle is not dissected. Revision can occur for a symmetric breast as well.

REVISION FOR HEMATOMA

Revision for hematomamay require evacuation of the hematoma with a drain placement. Revision of your skin flap with ischemia and skin loss can be associated with wet-to-dry dressing changes and subsequently debridement of the area and advancement flap closure.

WOUND SEPARATION AND DEHISCENCE

Wound separation and dehiscence may be associated with infection which needs to be treated prior to closure. Seroma formation can occur as well around the pedicle and this should be evacuated to prevent tension or pressure necrosis on the pedicle.

CELLULITIS

Cellulitis as described is usually associated with bacteria either streptococcus or staphylococcus aureus. This needs to be treated aggressively with intravenous antibiotics. Cellulitis will be treated with our patients immediately after surgery, given Keflex 750 mg p.o. b.i.d. and we may use Cipro 750 mg twice a day of they are penicillin allergic. We give all of our patients intravenously Ancef 1 gram unless they have pen allergies. We may then give Cipro or Vancomycin.

NIPPLE AREOLAR ISCHEMIA OR LOSS OF THE NIPPLE

If their blood supply is poor early on, this can often be salvaged by releasing sutures around the areola. The doctor needs to be diligent upon this.

DOG-EARS

Dog ears can occur. If they do, they can be removed over time by surgically excising them in a 4:1 elliptical fashion. Scarring must be determined, hypertrophic versus keloid. Remember, keloids are often worsened with revision excision and therefore it must be determined which one it is. Kenalog injections, steroids, are often used in order to reduce the scarring.

FAT NECROSIS

Fat necrosis needs to be resolved by debridement and cleaning the area with irrigation as necessary.

ASYMMETRY

Asymmetry can be corrected once the breast is completely healed by revising the breast reduction and redoing the scars. Nipple areolar complexes are often asymmetric and these can be redone as well in order to regain symmetry.

BREAST REDUCTION – TEENAGERS

Model

Model

Patients do present in their teenage years for breast reduction surgery.  These young women often have the same symptoms associated with bilateral breast hypertrophy, including large pendulous breasts with back pain, neck pain, grooving along the shoulder blades; however intertriginous rashes are less common.  There is also the emotional difficult psychological torment of having disproportionately large breasts at a young age, especially during the puberty years in which impressions in high school years are very important.

Recently, I had a patient present with 36DDD breasts and desired to reduce down to a small B.  The patient underwent the inferior pedicle Wise-pattern technique, approximately 280 to 320 grams of tissue was removed bilaterally, bringing the patient down to a small B.  It is important that all patients under the age of 18, as this patient was 17, must have a parental guardian, and we sit with the patients a minimum of two times with their parental guardian on two separate dates to review all consent forms.  Scarring is extremely unpredictable and therefore photographs of after postoperative breast reductions should be reviewed with the patient and the patient’s legal guardian.  Consent forms should be reviewed with the patient and the guardian in detail and signed accordingly.  Although patients at 17 may continue to develop further breast development for the next four to five years, at times reducing the breast at that age is the correct avenue, especially with disabling over-abundance of breast tissue causing chronic back pain and the emotional physical torment that occurs during their growing years.

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