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ABMS Maintenance of Certification

Certification Matters

 

I was pleased to receive a letter from The American Board Of Plastic Surgery, Inc. confirming my active participation in the Maintenance of Certification in Plastic Surgery Program. This letter and certificate are only available to ABPS board-certified plastic surgeons who have currently satisfied the MOC-PS requirements as of 2015.

When choosing a plastic surgeon, I would encourage potential patients to look for the Starmark logo when researching on-line.

Linder ABPS

AMERICA’S TOP SURGEONS 2014

EXCELLENCE 2014

I was honored to be recognized by the Consumer’s Research Council of America as one of their “America’s Top Surgeons” for 2014. Being chosen for this award is exciting and very special to me. This is the sixth year in a row for me and I appreciate this recognition.

HAPPY HOLIDAYS

HAPPY HOLIDAYS

Happy Holidays and New Years from Dr. Linder and staff. Here’s to a Healthy and Beautiful 2014.

Saint Moritz, Switzerland

Saint Moritz, Switzerland

Tubular Breast Deformity, Severe

The patient presents with severe tubular breast deformity.  Notice her preoperative photographs showing conical appearance to the breast, poorly defined inframammary folds, flattening to the bottom of her breast (left greater than right) and pseudo-herniation of the nipple areolar complex.  The patient is an exceptionally good candidate for tubular breast augmentation/reconstruction with high profile saline implants placed in the dual plane technique with radial striation of the lower poles of her breast.

The second photograph shows the markings that have been placed with 490 cc of high profile saline on the right and 505 cc on the left to regain symmetry.  She had partial resection of the retroareolar tissue with dual plane augmentation mammoplasty procedure as well as formal radial striation of the breast without any form of breast lift.  Her postoperative photograph shows a one-year postoperative result.  She has good symmetry, softening of the breast, excellent cleavage, inframammary folds are quite even and the nipple areolar complexes are quite symmetric.  Patient is extremely happy with the results of her tubular breast reconstruction.

Patients present to my practice with tubular breasts weekly.  I enjoy fixing this difficult problem, as only Board Certified Plastic and Reconstructive Surgeons specializing in breast augmentation and revisions should.

Breast Revision Multifactorial Deformity

The patient below in her preoperative photograph shows an out-of-state augmentation mammoplasty performed by a different plastic surgeon.  The patient is unhappy with the appearance of her breasts, the severe scar tissue contracture of the right breast with a ruptured left saline implant and the position of the nipple areolar complexes.  She has severe pain in the right breast with encapsulation, double-bubble breast deformity, grade 3 ptosis and complete rupture of the left implant.  The patient will undergo bilateral open periprosthetic capsulectomy, circumferential open capsulotomy, removal of ruptured saline implant replacement with high profile saline implants and formal mastopexy using the inferior pedicle Wise-pattern technique bilaterally.

 

The after results show still slight asymmetry of the left nipple areolar complex, slightly lower than the right.  This will be correctable over the next six months.  She however has nice placement of the implants after parasternal release of the parasternal attachments of the pectoral major muscle.  The implants were now able, after muscle tissue expansion, upper pole compression band and accurate inframammary fold release, to have the implant positioned in a more normal configuration.  The right nipple areolar complex sits nicely centrally.  There is a little bit of inferior displacement on the left which will be elevated under local anesthesia, performing a left periareolar mastopexy.

 

The patient is very pleased with her results.  She had severe pain in the right breast which as you can see has resolved as the implant is now positioned inferiorly in its normal pocket.  She has good sensitivity bilaterally and is undergoing scar treatment including Bio Corneum scar therapy, continues with tissue expansion massage of the right breast.  This is an example of a very difficulty multifactorial complex breast deformity by a transaxillary augmentation performed by a different surgeon, implant malposition, significant skin laxity that was not addressed and nipple asymmetry.

High Profile Saline Implants

The patient below is a 19-year-old Latin female presenting with bilateral breast hypoplasia, excellent candidate for high profile saline implants using dual plane technique, periareolar approach.  The patient desired to have natural-appearing breasts which can be performed with high profile saline implants as long as they are placed in the subpectoral pocket and positioning.  The periareolar incision site was performed and the implants were placed using the dual plane technique.

Her breasts appear to be quite natural and the patient is extraordinarily happy with the shape, size and appearance of her breasts.  High profile saline implants when placed in the appropriate position lead to a beautiful natural result due to the muscle allowing softening and the upper pole of her breast is seen in her oblique view.

IMDb.com An Online Entertainment Site

It was brought to my attention the other day that I was included in IBDb.com website.  Internet Movie Database (IMDb) is a online database of information related to television programs, films, actors, production crew personnel and fictional characters featured in the entertainment media. It is one of the more popular online entertainment media sites and I was excited to be listed for the various shows that I have been asked to participate in over the years.

 

 

Breast Capsules

post-operative breast capsules

Breast Capsules

One of the most common reasons that patients present for secondary surgery after breast implants is capsular contracture. Capsular contracture is associated with a hardening around the implant, saline or silicone that can be painful. The classifications include Baker I, soft supple breast; Baker II, palpable; Baker III, palpable and visible capsule; and Baker IV, palpable, visible, hard, distorted and painful. Patients who present with severe encapsulation have often thick capsules that are formed around the implants. The etiology of capsular contracture is not completely understood or ascertained at this time. It may be associated with a possible micro infection or staphylococcus aureus or epidermis. In any case, the capsule that forms around an implant is normal. All prosthetic devices in the body will have a capsule form around it over four to six weeks. The components of the capsule include: collagen, myofibroblast and blood vessels. The white shear appearance of the capsule as seen in the photograph is associated with a collagen formation. Capsules normally appear shiny and white in appearance; however, they can become thick, hard and darker in appearance, especially with calcifications of granulomas associated with silicone rupture. This is a photograph of capsule removed from the patient recently. She had a severe Baker IV capsular with painful breasts, hardening and distortion. The capsule is quite thick. It interdigitates with the undersurface of the pectoralis major muscle in this case. A small portion of the capsule taken usually cannot be completely removed without taking a small portion of breast tissue. This is why with recurrent capsular contractures and capsulectomies we have to be careful not to over-exenterate too much scar tissue.

Capsular contracture and ruptured implants are the two most common causes for patients presenting to my Beverly Hills practice for breast revision surgery.

Severe Baker IV Capsular Contracture with Severe Double-Bubble Breast Deformity

The patient below is a 28-year-old African-American female presenting with severe Baker IV capsular contracture, implant malposition, scar tissue, hardening with grade 3 ptosis.  Patient is an excellent candidate for total breast reconstruction which would include bilateral open periprosthetic capsulectomy, circumferential open capsulotomy, removal and replacement with style 68 high profile Natrelle 200 cc saline implants through a periareolar approach, removal of her larger 480 cc low profile silicone gel implants and a formal mastopexy using inferior pedicle Wise-pattern technique.  Her before photographs show severe encapsulation and the medial portions of her breasts show actual deformity of the implant edges.  She will require open periprosthetic capsulectomy, circumferential open capsulotomy, removal of the larger silicone implants, low profile and replacement with small high profile saline implants and a primary formal mastopexy.  Her after photographs show her in the Sexy Shapewear Linder Sport Bra.  Notice the reduction in size of her breasts.  Notice the fullness of the upper pole; however, she now has complete corrected nipple areolar complex position centrally into the breast mound.  She also has a beautiful proportionality from a Double-D preoperatively to a mid to full “C” postoperatively.  She is extraordinarily happy with her results.

The corrections of her breasts included placing the implants subpectorally, reducing the low profile to a high profile smaller implant, over-filling.  Subsequently, the formal mastopexy was absolutely essential in order to remove the redundant skin, especially when reducing the volume size of the breast implant and repositioning of the nipple areolar complex.  This is an open capsulectomy for a severe Baker IV capsule with severe malposition and distortion as well as a mastopexy to reposition the areolas and remove the redundant skin.

Ruptured Becker Implant Removal

CASE STUDY

 

This patient is a 57-year-old white female who presents with a 29-year-old silicone double lumen Becker/saline implants placed almost three decades ago.  She now presents with severe encapsulation, ruptured outer lumen saline with scar tissue contracture.  Note on her preop frontal view that she has superior retropositioning of the implant and a double bubble breast deformity.  She is in excruciating pain and the implants positioning has risen over the last two years.  MRI is showing both rupture and intra and extracapsular silicone extravasation, although there is no specific linguine sign and therefore no specific rupture of the shell, the outer lumen saline implant has been broken and the saline has resorbed.

In order to reconstruct this patient, multiple steps in the operating room were performed, including open capsulectomy, removal of silicone implant and calcified granulomas, inferior release and removal of the parasternal as well as the lateral inframammary across major muscle attachments.  This is the way in which the implant can maintain itself at a lower position and not rise.  Also implants will be constructed.  Patient had 140 and 239 cc silicone implants placed by gram weight on a scale in the operating room as the implant bags had no specific volumes inscribed on them as they do these days.  As a result, a 400 cc style 20 silicone gel placed on the right with 300 on the left open capsulectomies were performed, releasing and resection of the parasternal and the lateral muscle attachments were performed.  At this the patient was sat up, skin excess was marked out and a formal Wise-pattern breast lift was performed on the right with a vertical lift on the left.

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