The example here shows a patient with complete loss of upper pole fullness, severe ptosis, grade 3, the nipple is well greater than 3 cm below the fold and an implant has been placed under the muscle with a formal lift, removing skin both vertically and along the inframammary fold.  Her postoperative photographs show a nice elevation of the nipple areolar complex. 

This is a four-week photo.  Notice there is still some pink around the areolas and the vertical scars.  This, however, will soften with time.  The position of the areolas shows nice lifting and the nipples are at a direct straight out position.  It is safe to perform both implants and lifts at the same time as long as you find a qualified Board Certified Plastic and Reconstructive Surgeon who specializes in augmentation mammoplasty and mastopexy, understanding the anatomy and blood supply to the nipple to prevent any type of avascular episodes.

Note on example 1, the nipple areolas are actually quite stretched out.  She had a Benelli lift, around block technique, which simply caused stretching of the areolas with widespread subtle-like scarring.  She is very dissatisfied that the nipple areolas actually did not elevate whatsoever.  Rather, she ended up with widespread areolas and the nipples still in the low position.  The implant is high on the left with scar tissue contracture and is a flat moderate profile showing a very displeasing result.  Her after photo notably shows high profile 600 cc saline implants over-filled to 650 cc, open capsulotomy lowering the left implant and complete revision of the breast lift showing a nicer pattern to the nipple areolar complex, reducing the tension around the areola, allowing for a more rounded shape and less of a sunray appearance.  The vertical scar has actually healed quite nicely as well.

Example 2 indicates a patient who underwent augmentation mammoplasty procedure twice and a breast lift by a different surgeon with severe encapsulation and right double-bubble breast deformity.  Flattening of bilateral breast was extremely unpleasant to the patient.  She also underwent open capsulectomy, replacement with 700 cc high profile saline implants through the periareolar approach and then open capsulotomies high profile implants were used and then the nipple areolar complexes were reduced with a complete formal mastopexy.  The after photo shows a nice rounding shape to the breast, no longer flattening along the inframammary fold.  The nipple areolar complexes are now in the proper position.  The right one has been lowered and there is no further bottoming out.

Breast augmentation mastopexies require tremendous experience in judgment by Board Certified Plastic Surgeons.  Make sure your doctors are specialists in breast augmentation as well as reconstruction and revision when considering this difficult operation.

Dr Linder,

Thank You!  At 60 yrs with 3 surgeries behind me, I was scared to death to try to fix my problem again. From the first phone call with Nellie, ( I luv you Nellie!) she put me at ease and that gave me hope of walking in another office.  Meeting you, sealed the deal. You were so kind and understanding. Very professional to tell me you would ‘help me’ make the decision regarding size according to my body, skin, previous surgeries, etc..I was very, very afraid until I met you and your staff. You ARE a master at revision surgery!!  My boobs are wonderful, Awesome, in fact!!  The whole procedure was something to learn from. Choose the best and you won’t regret it!  Adrianna, I appreciate you!  All your help and kind hug made me cry! Surgery staff, you’re the best!! I will tell everyone, EVERYONE…if you want the best, see Dr Linder!!!!  Again, thank you soooooo much for my 20yr old looking boobies!!!

A.C

California

Other consultations that day also included mommy makeover, including breast implant lift, tummy tuck and liposculpture of the hips.  These patients present to Beverly Hills from Las Vegas for surgery, including breast augmentation, breast revision, breast lift, breast reduction, liposculpture, and abdominoplasty.

In general, lifting the breasts without implants requires a form of a breast lift  procedure.  For patients who desire a lift, but do not want larger breasts, a breast lift procedure including a periareolar crescent lift or small lift, a vertical mastopexy for mild to moderate skin laxity or a formal mastopexy using the inferior pedicle Wise-pattern technique or anchor scar is useful for complete tightening of the breast pocket.  Patients who present with significant amounts of breast tissue and grade 3 ptosis can have a nice breast lift without use of an implant.  It should be noted, however, upper pole fullness without an implant is never the same as with an implant, even a small implant.  As a result, patients often are not happy with breast lifts without a small implant because they do not achieve that same upper pole fullness as those women who have a prosthetic device placed in the superior, medial and central portions of the breast.  To lift the breast without a prosthetic device obviously requires tightening of the breast with skin removal.  Scarring is the most significant risk and this can include keloid hypertrophic scarring, widespread scarring, and hyperpigmentation. 

 We perform breast lifts in our Beverly Hills surgical practice every week.  This is for both primary as well as the revision breast surgery in which patients present with double-bubble deformities, grade 3 ptosis or severe skin laxity.

We continue to see breast augmentation patients weekly and have performed multiple surgeries on these patients every week of the year.  Both saline and silicone gel implant patients arrive on our doorsteps for surgery almost daily.  We believe that the demand for breast augmentation, breast revision, breast lifts and breast reductions will continue to increase over the next 10 years and that the trend shown by the New York Times article is accurate.

The patient underwent, through inframammary incision only, open capsulotomy, removal and replacement with smaller silicone gel implant by 225 cc reduction in size of implants, and subsequently an inframammary tightening procedure through the inframammary mastopexy well hidden along the inframammary fold.  The patient has done well and this is her three-month postoperative photos.  This is an example of bottoming out that can be corrected by an inframammary skin lift with a small internal capsulorraphy along the inframammary fold and a downsizing with significantly smaller implants.

 Examples of pseudoptosis will be shown.  Note that there is excess skin, however, the nipple is well below the fold which allows an excellent stretching of the skin of envelope by using saline and/or silicone gel implants under the muscle without the need for skin laxity.

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.

Dr. Linder is proud to be an advocate as well as a specialist for Kelo-cote on their recent infomercial now playing throughout the United States.  Because a disproportionately large part of Dr. Linder’s practice is body sculpting women, scarring is an inevitable concern, especially with the multitude of breast lifts and abdominoplasty surgeries. 

Having used Kelo-cote for over two years, Dr. Linder has found it to be extremely helpful when used after sutures are removed, twice a day, for at least three months.  Bio corneum is a new product with the Kelo-cote component as well as the SPF to reduce problems associated with the UV light.  Bio corneum is used for management and preventing keloids and hypertrophic scarring.  It is excellent for patients who have had surgical scarring and desires to have less redness, smoothing, flattening and less visibility of scars. 

The benefits of Bio corneum include:  it’s 100% silicone scar treatment with SPF30.  It dries within 45 minutes.  It flattens and softens scars, reducing redness and discoloration.  It also relieves itchiness and discomfort.  The SPF30 of the Bio corneum reduces sun-induced redness discoloration.  Bio corneum and Kelo-cote are excellent products for scarring.  Dr. Linder uses them every day on his patients who have postsurgical scars associated with augmentation, breast revision, breast lift and abdominoplasty procedures.

Women who have had children and/or breastfed, often what is called involutional upper pole atrophy or loss of fullness of their breasts.  Adding an implant as well as lifting the breast if there is significant skin looseness, leads to a beautiful reshaped breast.  The lower abdominal wall, when there is skin redundancy below the umbilicus but not above, may do well with a mini abdominoplasty.  A similar C-section like scar is made and extended toward the hips bilaterally and the tightening of the lower abdominal muscles from the umbilicus to the suprapubic region can be done at the same time.  The example of a mini Mommy Makeover above is showing breast enhancement surgery with a mini abdominoplasty.