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.

What is Body Dysmorphic Disorder (BDD) and Do You Have It?

True body dysmorphic disorder has to do with people thinking that one particular part of their anatomy is exceedingly deformed or completely incompatible with their happiness. We do see people with problems and do make great improvements in their looks and self-esteem. Most people don’t have this BDD diagnosis. This sort of person would be obsessed about something that to others looks like a minor issue. People suffering from BDD will insist over and over that their problem needs to be corrected. When a surgeon operates on an individual like this, sometimes they end up performing multiple operations, trying to make the patient happy, and no one, surgeon or patient, is satisfied.

This does not mean that we consider you to have body dysmorphic disorder if you think you need a touchup. The fact is that most individuals who want touchups are quite reasonable in their requests and have completely clear expectations about what to expect. They just need our advice about what is possible with touchup procedures. Please don’t hesitate to ask for improvement surgery after your initial surgery, because this often can effect a much more satisfied patient with improved results. As long as you are not obsessed with details, and can objectively listen to the surgeon’s opinion on what’s possible and what isn’t possible, BDD is very unlikely to be an issue.

All the best,

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Robert Yoho, M.D.


You Are Always Welcome in Our Office, No Matter How Long it’s Been

We have patients who are embarrassed to come back and see us, even ten years after the procedure, because they’ve gained weight or they haven’t taken care of themselves or they’re afraid there’s going to be some sort of charge.

Consultations are always free, and we particularly love to see our established patients back years after the event to see how they’ve done, see what’s happened in their lives, and let them know what’s happened in our lives. Our door is always open to any of our friends who just want to drop by and say hello and/or discuss another cosmetic issue or ask us what’s new. Visit my Los Angeles cosmetic surgery website for Liposuction Los Angeles and information about all the procedures available.

I don’t like to call these people “old patients” because it’s getting so I’m the “old doctor” and they’re the “young patient.” I like to call them established patients!

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Robert Yoho, M.D.

Am I A Surgical Candidate?

Dr. Yoho and friends in Argentina.

You are a surgical candidate if a number of things come together. First of all, you have to be psychologically ready for a surgery. Sometimes these things are stressful and sometimes they’re not, but you have to be willing to undergo the stresses of the possible complications for any of these given surgeries, however unlikely they are. Most cosmetic surgeries are comfortable and their post-operative recovery for most people is very modest, however. 

Second, you need to have good physical characteristics for the surgery that you desire. The doctor will help you understand just what kind of result you are likely to expect. For example, a woman with medium-sized breasts and a lot of breast tissue can get spectacular results with breast implants in most cases. A woman with long, skinny breasts sometimes needs reconstructive surgery and some of these surgeries come out better than others. Liposuction works very well for people with a lot of fat just under the skin surface, but doesn’t work at all for people with fat underneath the muscle wall. 

Of course, you need to be able to afford the procedure, and you need to be able to take the time off. If you are too busy to take the time off, many of the noninvasive procedures we do can, over time, make improvements that are as significant or nearly as significant as the invasive procedures. For example, our fractionated laser repeated several times can produce a fantastic result, and if you stay out of the sun and use Fallene sunscreen from drugstore.com (for example) and Retin-A over a year or two, you can get a fantastic result that rids you of wrinkles and really in many ways is as good as the invasive procedure which requires the two-week recovery and the possibility of more complications. 

Fillers can approximate a facelift for the right individual, replacing the fat and restoring the contours and form of the aging face to a younger contour, and when performed in conjunction with Botox and the resurfacing modalities, can be spectacular indeed. But the noninvasive procedures, remember, can be easily as expensive as the invasive procedures and require coming back to the office a lot.