Is It Important to Wear a Bra With Your Breast Implants?

I repeatedly emphasize to our patients that good bras are important or the breasts will sag. If they wear the bras and have support all the time, particularly for the first year when the scar is forming around the breast implant, often the breasts will be just as perky five years later as when the breast implant is placed. However, especially if the breast implant is a large one, the patient will have unpleasant, unnatural, and unsightly sagging of the breast. Here’s an example where the patient, in spite of all my admonitions, is wearing a very lightweight bra, at only two months after breast implant surgery. We recommended to her that she consider a heavier bra like the Bali Minimizer bra, and as always we told her to continue on her fish oil and Vitamin E indefinitely in order to keep her breasts soft.

Liposuction For Men - Six-Pack Abs

Did you know that you could have sculpted abdominal muscles from your liposuction procedure? There are new options available that can give you a chance to look your best. Dr. Yoho specializes in removing all the possible fat from this “six-pack” area of the abdomen and also injecting a little bit of fat in each square of your “six-pack.” This fat tends to be retained and creates a bulging muscular look. While the recovery takes a little longer than with ordinary liposuction, the results can be stunning. Additionally, we make a special effort to suction the fat from the creases of your abdominal muscles, thus creating more definition. Feel free to schedule a complimentary consultation about this exciting new procedure.

Information About Breast Surgery

We require patients to write out the following so they absolutely understand some of the complications of breast implant surgery: “There will be problems.” “We do not know what problems.” “I will feel the implant.” “I will have rippling.” “They will be unequal or asymmetrical.” “I will need to wear a bra to prevent sagging.” “Sometime in the future I may want or need a breast reduction or lift.”

After the patients write this, we discuss with them all the possible complications of breast surgery. Breast surgery has one of the highest satisfaction rates in our practice, and breast augmentation has been a mainstream procedure in America, with about 10% of women here having breast implants (at least in California). However, there are some problems. In the Allergan® implant study, a re-operation rate of 1 in 3 patients was found after 5 years for silicone implants. It is likely that the saline breast implants have a high re-operation rate also. The biggest problem is capsular contracture, which is a firming or hardening of the implants. This may occur in 5% to 10% of the patients who have breast implants. Fortunately, there are now some medical treatments for capsular contracture including fish oil, which I believe is an anti-inflammatory. We recommend a dose of 4 grams a day. Also, we have a medication called Accolate, which is FDA-approved for asthma. It is not FDA-approved for treatment of other conditions, and so this is an “off-label use of an on-label drug.” Doctors are allowed by law to use drugs that are approved for one disease to treat other conditions. Unfortunately, for Accolate, there have been a few reported instances of liver failure. The chance of liver failure seems to be one in several million per patient. By comparison, every person in America has approximately a one in 8,000 chance of dying in an automobile accident each year. In any case, we want our patients to understand that breast implants are not perfect.

One of the other complications we see, if the patients do not wear good bras, is a “rock in the sock” problem. That is when the skin envelope or the breast itself sags, and the implant sags down with it until you get a very saggy breast with an implant resting at the bottom of it. This can be prevented if a good bra is worn. We recommend wearing a bra at least during the day and, better yet, 24 hours a day for the first 7 to 8 months while the tissues are healing properly. We show our patients that a bra should put pressure on their shoulders and should lift their breasts. This is part of the advice we regularly provide during our complimentary consultation and during the postoperative process as well.


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Robert Yoho, M.D.

Advances in Breast Augmentation

Belly button breast augmentation or "TUBA" is one of the innovative techniques in breast augmentation surgery that has rendered obsolete many of the surgeries that leave scars on the breast, such as the through-the-areola approach. While some patients need to be treated by the through-the-areola approach because of odd-shaped breasts or other problems, the TUBA approach can put the implant in through the belly button without any scars anywhere near the breasts.

In experienced hands, this technique works wonders for many patients. It seems to have a lower rate of complications, such as capsular contracture, which is firming of the breasts. This complication accounts for the highest of all of the problem rates in breast augmentation surgery.

Dr. Peter Cheski pioneered and invented this technique, and Dr. Yoho learned his technique right from Dr. Cheski, working closely alongside him in his office over the years. Dr. Cheski was at the point where he could perform one of these surgeries in 10 to 15 minutes with virtually no help outside of a scrub tech and a sedation person who watched the monitor. He performed many tens of thousands of these surgeries over the years, and Dr. Cheski is regarded as one of the pioneers in breast augmentation.

Please come in for a look to see whether this procedure is appropriate for you. We love its results, but you must be evaluated before having the procedure.

Sculpting a Six-Pack

Did you know that there are new liposuction techniques that can get you more definition of your abdominal muscles than ever before? These new techniques include special aggressive suction of the fat in between the muscles, which can be done with ordinary liposuction or with other types of liposuction machines. Dr. Yoho’s belief is these new machines don’t yield any significant advantage. However, the real news is that a tiny bit of fat injected into the muscles of the abdominal area makes for greater definition and a much better result. This has to be done carefully and with experience, to ensure that the muscle squares are enhanced and improved. It helps to have good muscle tone before the procedure, but you don’t have to be slender. The liposuction itself can do that.

The Avelar Tummy Tuck

A relatively new procedure that we have performed is the Avelar tummy tuck. This form of tummy tuck provides a significant decrease in discomfort and/or complications experienced after the procedure. The incision used is similar to an ordinary tummy tuck, but in this new technique, sewing together the muscles is usually not done or not done as aggressively. First we use liposuction to thin the area prior to the removal of the skin, so as to loosen the skin, rather than just making a large hole between the muscle and fat and pulling the skin above the navel down. By using liposuction before the procedure, attachments to the skin are largely left intact, so blood circulation is in theory preserved, despite the removal of a large amount of skin from the lower abdomen.

An alternative to the Avelar tummy tuck is a simple dermolipectomy. This is a fancy name for removal of much of the skin of the lower abdomen without interference with the belly button area or the upper abdomen. These areas can then be reshaped with liposuction. The Avelar tummy tuck, on the other hand, does involve manufacture of a new belly button and stretching the upper abdominal skin all the way down to the upper groin area.

Latina patients benefit greatly from these procedures, because their skin often tends to be thinner, which can result in a less-than-perfect skin recovery after childbirth, with some stretch marks and looseness. We prefer to recommend the more conservative or less invasive procedures rather than more invasive, more risky, and more costly procedures, which can also involve more scarring. For example, we usually recommend the dermolipectomy more than the Avelar tummy tuck, and recommend the Avelar tummy tuck more than a normal tummy tuck. The risks, the scars, the cost, and the other problems are just not worth the extra investment of time and the more difficult recovery for these more complicated procedures, even if they are considered the “traditional approach.”

In fact, Dr. Yoho often recommends simple liposuction, and with his technique, the “no scalpel tummy tuck,” in many cases no skin removal is necessary at all, and the skin will shrink to fit. Sometimes a little loose skin is left above the belly button, but this is a small price to pay for not having a scar that extends from hip to hip and avoiding a very difficult recovery of perhaps a month or more, the pain and aggravation of more anesthesia and more surgery, and a higher price.

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Robert Yoho, M.D.

What's the Difference Between Juvederm and Restylane, and What's the Difference Between Botox and Dysport?

Hut at Baldy-Nothing to Do With Injectables

The two companies that manufacture these products are in direct competition, and they have done a great deal to confuse the value of their products in order to try to increase sales and compete with each other. The fact remains that in my opinion there is no substantial difference between Botox and Dysport. Dysport is measured in a slightly different unit measurement, but when all is said and done we mix it the same way and we deliver it the same way, and the costs are very close to Botox, although Dysport is a little cheaper for us. The chemical natures of the two products both produce the same wrinkle relief if administered in the same way, and the side-effect profile is almost the same (which is almost nothing).

As for Juvederm and Restylane, these are both hyaluronic acid products, and this certainly doesn’t mean that they burn! They are both reconstituted or mixed with a tiny bit of numbing medicine called lidocaine, which aids in the less painful (or virtually pain-free, in some cases) injection. They probably last a similar length of time in the body, which is perhaps a year. It’s our belief that these products last two years if delivered in larger quantity because the body’s natural mechanisms to break them down are slower when a larger quantity is used. They both stay soft in the face, and don’t generally produce any lumps, and both can be dissolved very easily with another injectable if you don’t like the results. While chemically a little bit distinct, they are essentially in the same class of usefulness, and both produce beautiful plumping effects of the face when used properly in the cheeks, lips, the folds around the mouth, and sometimes even the brows. The expertise of the person injecting is the critical factor, rather than the product.

I hope this clears up some confusion, but remember when reading anything from a manufacturer: it’s all about marketing. Get the straight scoop from your health-care provider.