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Breast Augmentation

The Procedure

Breast augmentations enhance the breast size, shape, and enhanced cleavage and in some cases, reducing skin laxity and tightening of the skin from the inside out.

Implants

In the majority of cases, Dr. Linder performs subpectoral dual plane technique saline and silicone augmentations. The implants are placed behind the muscle in order to reduce the risk of scar tissue capsular contracture, visibility and palpability of the implants.

Profiles

The specific implants used depends upon the amount of breast tissue and the appearance the patient desires to achieve.

Low

Useful for women desiring less projection.

Least common

Moderate

Useful for women with thick chest walls.

High

Useful for patients with thin chest walls.

Most common

Extra High

Useful for patients who desire a larger implant .

Techniques

Inframammary Periareolar Transaxillary Transumbilical
Easy To Conceal No Yes Yes Yes
Effects Breast Feeding <5-8% 5-8% <5% <5%
Incision Point Breast crease Under areola Armpit Bellybutton
Recommended Yes Yes No No
Scarring Yes Yes No No

Subpectoral Vs. Subglandular

The majority of our patients are submuscular. Subpectoral approach is performed and using the dual plane technique two-thirds under the muscle medially and one-third over laterally. This allows cover of the medial implant and reducing visibility along the sternal area and cleavage region, also reducing capsular contracture and scar tissue formation.  It has also been shown to be helpful for mammograms and MRIs through the radiologist in detecting cancers.  

The subglandular approach may be useful for patients with severe tubular breast deformity; however, in the majority of these cases I still yield dual plane technique with the last sum medial muscle coverage in case the patient should have weight loss in the future, which would lead to visible palpable implants.  Remember, once an implant is placed above the muscle, it is difficult to recreate a subpectoral pocket in the future and therefore the majority of cases I perform submuscular pocket during all primary augmentations.

Breast Implants Facts

  • Breast implants have been shown to have no higher incidence of fibromyalgia, systemic lupus, autoimmune disease or increased risk of breast cancer than those women who have had no implantation.
  • Gummy bear implants can be problematic in that rotational deformities can occur with even five degrees of rotation.
  • Silicone implants do not increase the risk of autoimmune disease or breast cancer in patients
  • Silicone gel implants are smooth walled and round.

Implant Manufacturers

  • Allergan Pharmaceuticals
  • Mentor Corporation (now with Johnson & Johnson)
  • Sientra

*All manufacturers are FDA-approved

Silicone Implants

Silicone implants were reintroduced in November 2006 by the FDA for the use of primary augmentation, primary reconstruction and revision augmentation patients for women of 22 years of age and over. They may be used on women under the age of 22 with specific diagnosis of congenital breast asymmetry, reconstruction or breast cancer reconstruction. Silicone implants have been found by the FDA to be safe.

Pros Cons
FDA approved Must be 22 years of age and older
More natural appearance Capsular contracture
Ideal for thin chested women Higher rate of scar tissue formation
Implants have stronger shells Inability to detect rupture without MRI

Saline Implants

Saline implants with Allergan Pharmaceuticals come in three profiles. Although they are all round, they come in low, moderate and high profile saline implants. By physics, the rounder and more full with increased projection the implant has the less visibility and rippling with size of the bag will show.

Pros Cons
FDA Approved Less natural look
No risk of extracapsular spread of silicone Easier to identify implant edge on outer breast for thin patients
No diagnostic testing needed to detect a rupture Harder to palpation
Less expensive than silicone implants Possible leakage through valve

Anesthesia

Breast augmentations should be performed under general anesthesia with a Board Certified Anesthesiologist.

All anesthesia is performed by Board Certified anesthesiologist, Dr. Hoffman.

Laryngeal mask airways can be used in the majority of the patients.  However, those who have a history of reflux or gastroesophageal disease are usually better candidates for endotracheal tube intubation.  This should be discussed with your Board Certified Anesthesiologist.

Cost

Breast augmentation cost will vary per patient.

This includes surgeon’s fee, operating room fees, implant cost and anesthesia fees. In general, silicone implants are more expensive than saline implants. They are more expensive from the manufacturer directly to the surgeon.

Breast revision surgeries are more expensive than primary in that there are multiple procedures that are required in order to reconstruct the breast, including capsulectomies, capsulotomies, capsulorrhaphies, repositioning of the implants and mastopexies and skin tightening in order to recreate a normal appearance to the breast.

Surgery Time Table

Preoperative Patient is started on an intervenous antibiotic (Ancef, Cipro and Vancomycin).
Surgery A primary augmentation takes between 45 - 60 minutes.
Recovery Room At least one hour. This is a requirement of federal law in Medicare.
After Surgery Patients are sent home with a Bias wrap and gauze in place. No heavy lifting or raising the arm above the shoulder for three weeks.
Postoperative Visit All dressings are removed.

An upper pole compression band is placed which allows the implant to maintain an inferior position and softening of the muscle so that there will only be natural occurrence over the next four to six weeks.

Recommendation: The Linder Bra is a double clip zip mechanism, which allows easy placement with new gauze. It costs $49.95.
Day 7
Follow Up
Breasts are examined for bleeding, infection, and positioning of the implants
Days 8 - 14 Changing of the gauze will then occur twice a day for the next seven days.  

Patients will do this at home
Day 14
Follow Up
The upper pole band may or may not be discarded, depending upon the placement of the implant at that time.  

Sutures are removed

If there is any evidence of significant scabbing patients are asked to return in five days for final suture removal
Days 14 - 21 Light activities can resume.

Incisions can get wet while showering.

Post Operative Medication*

Name Image Type Duration Form Dosage Frequency
Ciprofloxacin white Ciprofloxacin round pill labeled with cipro and 500 Antibiotic 7 days Pill 500 milligrams 2X daily by mouth
Flexeril Five sided orange colored Flexeril pill Muscle spasm - Pill 10 milligram As needed
Keflex** two toned green round Keflex pill Antibiotic 7 days Pill 500 milligrams 4X daily by mouth
Norco white round Norco pill Pain control - Pill 7.5 milligrams As needed
Vicodin White round Vicodin pill Pain control - Pill 7.5 milligrams As needed
Zofran Mustard yellow colored round Zofran pill Nausea & vomiting prevention - Orally Disintegrating Tablets 8 milligrams Every 6 - 8 hours or as needed

*These vary per patient, and may not be recommended for everyone

**Not recommended for individuals with allergies to penicillin

Frequently Asked Questions

» Is Dr. Linder board certified with the American Board of Plastic Surgery?  

Yes. There are absolutely no substitutes.

» How many years has Dr. Linder been performing breast enhancement procedures?

Since 1997

» How many surgeries has Dr. Linder performed?

Over 10,000 breast implants placed since 1997.

» How many breast augmentations and breast revisions does Dr. Linder perform on an annual basis?

Roughly 500

» In which states is Dr. Linder licensed to practice surgery?

California and Nevada

» Where will the surgery be performed?

Brighton Surgery Center - It is a Medicare Licensed Surgery Center in Beverly Hills, California.

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