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.

Indications for use of The Dr. Linder Bra include: 1) as a sleeping beauty bra for women, with or without breast implants, to maintain the shape of their breasts throughout the evening so as to not have continued or recurrent skin laxity and loss of firmness to the breast; 2) as a training bra that can be used for the aerobic and anaerobic workouts to maintain the shape of their breasts during vigorous athletic activities as well as during Pilates; 3) as a pregnancy bra, due to the patented adjustable straps on the side of the chest wall, they can be adjusted to three different sizes and can be used for women in their 9-months pregnancy period as well as post-pregnancy during breast feeding; and 4) can be used post-surgically for breast cancer as well as elective cosmetic breast surgical procedures, including breast reduction, breast augmentation, mastectomy as well as breast cancer reconstructive patients. 

This Bra is not a surgical bra per se, but rather 24/7 hour bra that again can be used for training, sleep bra and beauty bra to maintain women’s breasts, every day bra to be used throughout the world, as well as for pregnant women whose breasts will enlarge over nine months and finally for post-surgical patients. 

The Linder product line will include The Linder Sport, which is the Linder Bra without the zipper in the front as well as The Linder Band, which will be useful for the abdominal area to reduce the abdominal midriff area up to two inches.  The Linder Bra manufacturers with the highest quality of approximately 95% cotton and 5% Spandex as bi-directional stretch, which thereby means has compression which will also allow women to perspire without development of consistent sweat within the bra.  It has excellent evaporative properties and will also have the adjustable straps on the sides with the Ford Steel Clip System which can be adjusted in three different sizes along the chest wall diameter.  This is a very unique bra.  It has been trademarked and is patent-pending at this time.  Manufacturing is occurring and should be completed in the next couple of months. 

Look forward to the informercial as well as selling of the products in multiple stores as well as training stores, sporting good stores and pregnancy stores for women.  We are very excited about The Dr. Linder Bra which will be very useful for women throughout the world for all their maintenance as well as training and post-surgical pregnancy needs.

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.

This Bias compression wrap has been very useful to allow for the accommodating immediate acute swelling which will occur without constriction of the neck area or the chest region.  It also allows for compression and may be useful for reducing some small microcapillary bleeding.  In any case, we use the Bias wrap on all of Dr. Linder’s immediate postsurgical patients whether they are augmentations, breast revisions, breast lifts or breast reductions.  Please see the following picture.

Steri-strips are used on breast incisions unless the patient has a preexisting history of tape allergies at which time Xeroform (yellow impregnated gauze) will be used (see Photo #2), which can then be placed on the incision sites which is not adherent to the skin and does not cause blistering. Immediately, on postop day #1, the dressings are removed and patients are placed in athletic bras or surgical brassieres and all dressings and 4×4s are replaced as well.

In the Acute Phase or first six weeks postoperatively, Dr. Linder instructs his patients not to do any heavy lifting over five pounds to prevent bleeding and hematomas, as well as to refrain from aspirin, Advil, Motrin, Excedrin, Ibuprofen or blood thinning products which could cause clotting deficiencies.

Acutely, we also make every attempt necessary to prevent infections by preventing water and sweating to the incision site around the areola.  This can be done by keeping the incisions clean, dry, changing gauze twice a day for 14 days, maintaining Keflex, or oral antibiotics for 7 days postsurgically.  Keflex 500 mg q.i.d. or pan allergic patients Cipro 500 mg p.o. b.i.d. times one week.  Our patients are maintained in athletic sports bras and upper pole compression bands in order to lower the implants to a correct anatomical position which has a more natural appearance.  Our implants are placed in the dual plane at least two-thirds under the muscle and lateral third subglandular and the upper pole band relaxes the upper pole muscle and softens the implant pocket, lowering the implant to a nice position.

Delayed or chronic postoperative care should include, once all sutures are removed and the patient is happy with the position of the implants, supportive brassieres all the time.  At night patients should wear athletic sports bras in order to maintain position and prevent malposition and displacement of the implants during the sleep phase and during the day, underwire supportive bras are useful in maintaining the inframammary fold and preventing bottoming out of the implants. 

These are Dr. Linder’s specific instructions.  Other surgeons may have their own postoperative management and care.  Please refer to your own surgeon for his or her specific instructions.

Areolas can be reduced in size when they are greater than 4.2 cm.  In general, as Board Certified Plastic Surgeons, we vary the range of nipple areolar complexes from 3.8 to 4.4 cm in size, often associated with the proportionality of the woman’s breast and figure.  We use 4.2 cm cookie cutters or 42 mm cookie cutter patterns in breast lift and breast reduction procedures in order to remark and reduce the nipple areolar complex to a smaller uniform size.  I personally use 4.2 cm on the majority of my breast reduction and breast lift surgeries.

Aerolar Breast Reduction Before and After

Reducing an areola that is quite large, for example, 6 to 8 cm down to 4.2 without a vertical incision, although may be easy to do, the final results may be quite poor.  The reason is areolar reduction performing a Benelli or round block technique, often leads to pin cushioning around the areolar which thereby may lead to radiating sun scarring appearance as well as widespread scars.  As a result, I frequently persuade my patients not to undergo areolar reductions without a vertical component or a vertical lift with the areolar reduction.  The vertical lift actually will reduce the wide-spreading of scars around the nipple areolar complex by eliminating tension around the areola and bringing it to below the nipple areolar complex at the 6 o’clock position in a vertical fashion in which the scars usually spread less.

Breast reduction surgery when performed correctly will lead to an excellent result.  It will reduce the size of the weight, reduce functional problems, including back pain, neck strain, grooving around the shoulder blades, etc.  The tradeoff for a breast reduction is scarring.  Scarring can be unpredictable, although there are techniques that may help to improve the final result.  Techniques are as follows:

1. Make sure you go to a Board Certified Plastic and Reconstructive Surgeon, a Diplomate of the American Board of Plastic Surgery who is trained and qualified to do breast reduction surgery.

2. Closure of the incision should be performed subcuticular whenever possible in order to reduce external scarring.  In other words, stitches should be placed underneath the skin as much as possible to reduce stitch marks.

3. The correct approach.  A predictable and safe approach to large breast reductions, at least according to Dr. Linder, is using the Wise-pattern or anchor scar technique where an incision is made around the areolar vertically along the midline of the breast and along the inframammary fold.  This allows for correction along the vertical plane as well as along the inframammary fold and the horizontal plane and reducing tissue from both planes which will then allow for a round, nice shape to the breast.

4. Medicare State Licensed Ambulatory Center and a Board Certified Anesthesiologist for the safety of the patient.  This is a must in that a Board Certified Anesthesiologist will be able to take care of the patient’s airway and correct any problems in the operating room that may occur.  There is no substitute for a Board Certified Anesthesiologist.

5. Postoperative care for the suture lines should include scar treatment which Dr. Linder uses Kelo-Cote silicone gel spray in order to reduce scarring for a three-month period, twice a day, once all sutures are removed.

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.

Please refer to www.breastrevisionsurgeon.com for further information on scarring.

Today, May 20, 2009, I will be performing two of these operations, enhancing women’s breasts who have already undergone breast reductions who have minimal breast tissue.  One will undergo saline augmentation using high profile implants behind the muscle and the second will undergo silicone gel implants in a similar pocket due to the minimal amount of breast tissue which could lead to increased visibility and rippling, especially along the lateral breast areas.  These patients will also undergo revision breast lifting by tightening the lateral inframammary fold in order to reduce the boxiness shape of the breast and regain a round and more narrowed breast appearance. 

Breast implants should be placed behind the muscle whenever possible in patients who have undergone reduction mammoplasty procedures in order to reduce visibility, palpability and increased risk of capsular contracture. 

It is important, in my opinion, to not go too large with your implants to reduce upper pole fullness as this could lead to round, fake and an unnatural appearance.