Because Dr. Linder performs so many surgeries where scarring is such a significant part of his procedures, including mastopexies, breast lifts, abdominoplasties and breast augmentations, reducing the scarring is absolutely a main necessity.  The best product that we have used, certainly in the last decade, has been Kelo-cote or Bio Corneum.  Kelo-cote is a silicone gel spray which is used twice a day after sutures are removed, usually on day 14 to day 21, for at least three months.  The silicone gel spray greatly reduces the redness as well as hypertrophic keloiding of the scars and has smoothed out scars beautifully over the last two years. 

Look out for the next one and two-minute infomercials from Kelo-cote where Dr. Linder has been used as a scar expert for Advanced Bio Technology.  Because we believe so wholeheartedly in the use of Kelo-cote, giving worldwide testimonial as to the benefits of Kelo-cote, goes without reservation.  We look forward to seeing the Kelo-cote used worldwide and on television sets throughout the country.

Example No. 1 below shows a patient with significant bilateral breast hypertrophy with Grade 3 ptosis bilaterally.  The right breast is a 36E size breast, the left is a “B.”  In order to properly repair her breast, reconstructing it, she underwent a straight breast reduction procedure using the inferior pedicle Wise-pattern technique on the right and a breast lift on the left with a small 200 cc saline implant.

Example No. 2 shows breast asymmetry requiring a larger saline implant on the left with a straight formal mastopexy on the right to regain symmetry. 

The third result shows breast asymmetry repaired with simply breast implants of different volumes.  The right implant was a 510 cc implant and the left 420 cc.  This allowed for excellent symmetry of her breasts. 

Breast asymmetry is an operation that requires skill and experience and the surgery leads to extraordinarily satisfied patients, especially when they are trying to recreate a normal appearance to their breasts.

The case example below indicates a young female who desired a very natural full B, small C, final result that had slight breast asymmetry.

Upon reviewing her preoperative photos, it is obvious that the right breast is slightly smaller than the left and that the right inframammary fold is higher than the left.

The patient desires to have natural result and, however, has a narrow base diameter of 12 cm and will do well using high profile cohesive silicone gel implants.  A 300 cc implant was placed on the right, 280 cc gel was placed on the left.  This was done using the dual plane technique and through the periareolar approach underneath the areolas.

These results are six weeks postoperative, approximately 90% of the swelling is reduced, the implants successfully fall into the proper position by the use of an athletic sports bra without underwire for one month and an upper pole compression band that has softened and relaxed the muscle on the upper pole to allow the implants to fall into its natural position.

Patients over the age of 22 who desire the most natural results possible and have minimal breast tissue may have successful results using cohesive silicone gel implants of slightly different size volume in order to correct the asymmetry.

Massive breast hypertrophy, also referred to as gigantomastic breasts, can also occur in teenagers, referred to as juvenile breast hypertrophy or gigantomastia.  These patients may not be able to wait until 18 years of age to undergo reduction mammoplasty to reduce the massive size of their breasts, just due to simply increased pain, neck strain, grooving along the shoulders, physiological and emotional embarrassment.  These patients also may undergo surgery at a younger age if considered clear both mentally and physically, as well as with parental supervision for consenting the patient.

In general, when patients decide on body contouring, including augmentation mammoplasty procedure and liposuctioning and are under the age of 18, we normally have the patients wait until the age of 18 so that the majority of physiological breast growth is completed.

When a patient has already undergone breast augmentation with saline or silicone and will undergo breast revision surgery to correct this problem that wasn’t corrected initially, several approaches can be taken.  Breast revision surgery for secondary breast asymmetry problems include:
1. With saline implants refilling or reducing volume of one implant.
2. Replacing the saline implant altogether presenting a larger saline implant.
3. With silicone implant replacing with a larger or smaller silicone implant to the asymmetric side.
Patients who present to Dr. Linder in both Beverly Hills as well as in his Las Vegas practice, present with breast asymmetry preoperatively.  These patients’ folds are marked.  The distance of the inframammary folds must be identified and the distance between the inferior areolar to the inframammary fold distance shall also be reviewed.  Patients should be asked and clinically examined for obvious asymmetry in a brassiere.  When it is identifiable significant and saline implants are to be used before original surgery has occurred, then a different size implant of different volume will usually be used.  If the asymmetry is only slight, then the same implant volume, however, titrated differently.  For example, a 400 cc filled to 400 cc and a 400 cc filled to 430 cc can be placed in order to regain symmetry.  With silicone patients this is more difficult in that silicone implants will require obviously a standard pre-filled implant which cannot be changed in the operating room in terms of titrated volume.  The smaller volume of silicone implants has shorter ranges.  For example, 25 cc differences which can allow for increased symmetry.  As you get into the 500’s and larger, the volumes up by 50 cc make it more difficult to titrate the symmetry volumes.
When a patient presents with asymmetry after original breast augmentation and has saline implants, we like to obtain the previous operative report and implant catalog lot number and serial number with implant volumes identifiable.  Frequently, patients do not have access to the records and therefore Dr. Linder in the operating room has to make his own judgement through his experience of thousands of breast surgeries and revisions to determine the proper size and most appropriate volume.  Most importantly, remember that breast asymmetry, both before the original breast augmentation as well as after the primary augmentation is the norma and regaining absolute perfect symmetry is difficult, if not completely impossible.

Breast asymmetry can be congenital which often presents with a larger saggy breast on one side and a smaller, more conical or tubular shape breast on the other side with poor or arrested development. To repair these, usually the smaller breast only requires an implant as long as the nipple is above the inframammary fold. The larger breast which is saggy, will require a smaller implant obviously, as well as a breast lift.

The breast lift normally will either be a vertical or a formal mastopexy using an inferior pedicle Wise-pattern or an anchor scar. Implants of different sizes can be used. In general, we prefer to use saline implants with significant breast asymmetries because we can titrate the volume of the implants which can lead us to more precision, accuracy and final breast volume.

Silicone gel implants, however, can be used if the asymmetry is slight and not too significant. Breast asymmetries are seen in most women, at least slight asymmetry, however, when they become significant, they can be physically and psychologically tormenting to the woman’s self-esteem. Repairing asymmetries, once again, usually requires placing the implant, either saline or silicone, in a dual plane (half under and half over the muscle or two-thirds under, one-third over depending upon the thickness of the muscle), as well as reconstruction and removal of skin on the saggy breast side, which can be performed by simply removing skin around the areola and along the vertical plane and along the inframammary fold. To completely correct breast asymmetry, the absolutely correct breast lift must be performed. When a patient has grade 3 ptosis and the nipple is well over 3 cm below the inframammary fold, a formal mastopexy is usually required and that is an anchor scar.

When patient have a conical or tubular breast on one side, this can be easily enhanced with a larger saline or silicone implant and release of the tubular inferior pole of the breast with radial striations of the lower pole above the pectoralis major fascia is performed in order to round out the lower pole of her breast.

Dr. Linder enjoys fixing breasts from patients throughout the world and right here in Beverly Hills. Breast asymmetry is a challenging operation. Only Board Certified Plastic Surgeons should be performing these operations. They have the experience and judgment to allow for a reasonable and favorable result.

Before: Right 34C Left 34A After: Right Mastopexy Left 390cc

Dr. Linder absolutely loves the challenge of reconstructing breasts that are completely different. In general, breast asymmetry is not that abnormal. Usually, one breast is small and tight and may be tubular in shape while the other breast is usually significantly larger, up to two to three cup sizes larger and is sagging, which will require a breast lift concurrently with implants placed.

We see patients throughout the world and right here in Hollywood, celebrities, actresses and mainstream Hollywood directors, producers, etc., who present with deformities of their breasts associated with asymmetry. We love the challenge of fixing these and are happy to work with each patient on their individual needs.