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 Biggest Issue in Breast Implants Part 3: Breast Implantation Issues

Judy in Trinidad

How is capsular contracture or hardening of the breast implants treated?

First, as mentioned in the past essay, we attempt to prevent this by encouraging the consumption of fish oil and Vitamin E. These home remedies are not clearly established to prevent capsules, but there is a lot of circumstantial evidence suggesting that they do.

Second, if you have a capsule, there are various remedies, and one of the things that has been thought to work is a medicine for lung disease called Accolate, or another related medicine called Singulair. These brand-name medicines are commonly used by lung doctors to improve lung functioning in certain kinds of asthmatic and other conditions. They have a very small statistical rate of some serious problem, so be sure to talk to your doctor about these before taking the medicines. In any case, they're expensive and they need to be taken for four to six months in order to be effective. The earlier you catch your capsule, in other words, the softer the breast is before starting the medicine, the better chance you have of correcting the problem with a medication.

We also increase the fish oil to a higher dose, although as stated before, this is not clearly known to be effective. We have seen interesting cases in which a person who stops taking their Vitamin E or fish oil and develops a capsule within a month, but of course, this doesn't prove anything for sure.

Surgery for capsular contracture is problematic, because the chances of the problem coming back are very, very high after most any surgery. The traditional approaches include removal of the capsule, which sometimes is difficult, especially under the muscle, and replacement of the implant in a different plane. This means that if the implant was above the muscle, you put it below the muscle; and if it was below the muscle, you put it above the muscle in the secondary operation. The chances of a return of the hardening of the breast after these surgeries is a disappointing nearly 50 percent.

Unfortunately, the Allergan study, which encompassed many, many thousands of women with breast implants and silicone gel implants, had a secondary operation rate of about one in three after seven years. This means that you must not view these things as a permanent solution to small breasts unless you're lucky.

Judy, my wife, has had her implants for about 15 years and has never had any problem except for a slight firming on one side, so she might be the exception rather than the rule.

Best of luck, and if you get breast implants, be sure you have a good surgeon who will be happy to follow you for any problems afterwards.

What's the Difference Between a Plastic and Cosmetic Surgeon?

Question:
"What's the difference between a plastic and a cosmetic surgeon?"

Answer:
The best explanation is produced by the American Academy of Cosmetic Surgery. We have reproduced this at DrYoho.com; click here to read more about plastic vs. cosmetic surgeons


Basically, cosmetic surgery is a field of beautification surgery. This includes eyelids, facelifts, breast enhancements including lifts and breast augmentation, and liposuction, among other surgeries. Plastic surgery also includes many other types of surgery, such as hand surgery and complex surgeries cooperating with other surgeons doing reconstruction work. Plastic surgeons typically work closely with other surgeons in hospitals to perform care on sick patients. Some of them also do Los Angeles / Fresno area cosmetic surgery.

If you want to read a comprehensive article about how to choose your surgeon, and understand just how the physician training and experience impacts the performance of various surgeries, refer to this chapter of my book on cosmetic surgery.

This is a pretty complex subject and you need to exercise some judgment and do your homework. Be sure to verify the credentials of your Los Angeles / Fresno area cosmetic surgeon, and research their methods to get a better idea of your options.

Nutritional Therapy Before and After Surgery

Everyone knows that proper nutrition is important. But did you know that nutrition can influence the infection rate? And help healing of open wounds? And make any given patient respond to the stress of surgery better?

I have had many patients who have responded to my nutritional therapy, which I have used to treat complications including large open wounds lasting many months after other physician’s surgical procedures were referred to his clinic. I have cured some of these in just a few weeks using proper nutrition. One of my latest cases involved an infection from a Fresno / Los Angeles area breast augmentation procedure, that was draining - even after the implant was removed - for 8 weeks. I supplied the nutritional therapy described at the above link, and the drainage went away in 3 days and the wound closed soon thereafter.

While proper protein supplementation, vitamin C, Zinc, and other supplements are clearly helpful in some cases of surgical healing, wheat grass pills (usually 5 tablets two times a day, available at wheatgrass.com) may seem like a non-traditional idea. But in my experience they can really help in some cases.

All these therapies must of course be used with good traditional care, such as proper wound care, and possibly antibiotics if infection is demonstrated. If you are not confident that your Los Angeles or Fresno area cosmetic surgeon is offering the quality of nutrition you need, you should contact my Fresno cosmetic surgery area office in Visalia and schedule a meeting to talk with me personally.

For more information on healthy nutrition and post-surgical healing, you can also visit my cosmetic surgeon Los Angeles site, 

Breast Lifts & Reduction in Fresno

Question:
Traditional Breast Lifts/reduction versus the new “Vertical Mastopexy/Ice Cream Cone” Breast Lift (with or without implant or reduction) - what's the difference?

Answer:
When you are unhappy with your breasts, there may be three reasons:

1. volume
2. shape
3. positioning

Positioning really refers to how saggy the breasts are. If your only concern is volume, and you don’t have a problem with the shape or positioning, Fresno, CA breast reduction using liposuction, or a breast implant, may be the best choice. Most patients can achieve a one to two cup size reduction with liposuction, and a 1 to 2 inch nipple elevation with liposuction alone.

If you are concerned with the shape but you generally like the size of your breasts, then the "Ice Cream Cone" / Vertical Mastopexy may be the procedure of choice for you. This procedure can provide a volume reduction if necessary but its primary function is to shape the breast and re-position the nipple-areola area. If for some reason after this procedure, you decide you want a bit more volume, it’s not a problem to place an implant 4 to 6 months later. About 50 per cent of patients choose to put an implant and 50 per cent are happy with the lift only without implant.

Note that the traditional “anchor” scar procedure is generally regarded as not as satisfactory as the vertical mastopexy. This older procedure needs a scar all around the bottom of your breasts plus a scar up the middle, plus a scar around the areola as well. It does not hold up as well as the vertical mastopexy, and tends to sag sooner. Also, the newer procedure needs only a scar down the middle of the front of the breast and around the areolas.

Remember whatever choice you make, if you need a breast augmentation Fresno, it’s always better to do this procedure in two surgeries. This is because if you have the implant put in and reduce the breast as well, the forces on the breast tend to pull the scars apart. When you do the lift first, then put the implant in later, the breast tissues hold up better and there’s less risk of sag and other unsatisfactory results.

Note: I do not not usually perform the anchor-type scar procedure, the traditional breast lift. However you can view my gallery of past breast lift before and after photos to get a better idea of what the vertical mastopexy can achieve.