What is it Like to Have No-Scar Breast Implant Surgery-Part 3

Here you are out of surgery and in the recovery room, waking up. Will you be in pain? Odds are, you’ll wake up smiling. Most patients ask, “Are we done yet?” You shouldn’t experience any pain. Typically, you will have a slight feeling of the weight of the new implants. You will probably also feel a sensation of tightness. With the light sedation, you’ll probably need only 20-30 minutes before you are fully awake and ready for your ride home.

Your local anesthetic (remember that the local was given internally?) will last for your ride home so that you can settle in and get comfortable. On the evening after surgery, the local anesthetic will wear off. At this point, you can have some pressure and discomfort in the chest area, and perhaps some in the abdomen (from the belly button incision and tubes). You will have pain medication to take for relief from any soreness. Everyone has a different pain threshold, but the pain medication should offer plenty of relief. You might also experience some feelings of nausea for a couple of days as a side effect of anesthesia. If your surgery was performed under the light sedation, this is less likely.

As recommended by Dr. Yoho, you will be resting in the recovery area that you prepared in your home ahead of time. Your recovery area might be in your bed or in a recliner with several fluffy pillows to support and keep you elevated. You will also have bottled water, your post-op medications, your mobile phone, remote controls, books, a laptop, and some light food. All of the items that you need are within easy reach—possibly even a bell to call any friends or family members who are helping you to recover at home.

You will need to be patient for a while, because for a few days you will not be able to bend over, raise your arms, or get out of bed with ease. Dr. Yoho has also instructed you not to lift anything for the first few weeks. Many TUBA patients feel okay within a day, and others within a few days. But everyone is different and you should listen to your body. Your recovery should go smoothly if you follow Dr. Yoho’s instructions for post-operative patients. Since your consultation, you know that the best breast augmentation surgery recovery happens for patients who take good care of themselves and follow their surgeon’s instructions.

The day after surgery, you will return to Dr. Yoho’s office. Your dressings will be removed in this follow-up appointment. After that, Dr. Yoho will still be available to answer any questions or address concerns, and his office will follow up with you. During the healing phase over the next few weeks, you will experience many changes. Don’t panic. Common experiences include: an increase, decrease, or loss of sensitivity; hot or cold sensations; pins and needles; or you might even hear crackling under the skin. Less commonly, you might see bruising of the breasts, your breasts might appear pointed, asymmetrical (different sizes), flat, too big, too small, too high or too low. These conditions might be normal for your surgery. You will need to be patient with these changes, but if you feel concerned, call Dr. Yoho’s office.

If you had sub pectoral implants (under-the-muscle), your recovery might be a bit longer or more intense, but should result in a smoother appearance of your breasts. With under-the-muscle breast implants, you might have more soreness, muscle tension, or spasms in the upper back, and the pressure of the muscles might cause the breasts to look constricted. These recovery symptoms will not last long, but the muscles will need to heal from the trauma of surgery before they heal to a normal look and feel. Again, you can call Dr. Yoho or his staff at any time. After recovery, you will get used to your breasts and they will continue to improve in look and feel.

What it is Like to Have No-Scar Breast Implant Surgery, Part 2

When we left off, you were in the middle of your transumbilical breast augmentation surgery. You had been sedated, had an incision made in your navel, and an instrument had tunneled up to each breast. This allowed for the balloon-expander to create the space for your new implants. When this is removed, the space is then checked for bleeding. Remember that the pressure of the balloon expander has probably stopped any bleeding so far. Then the new pocket is irrigated with a sterile saline solution containing an antibiotic. Antibiotic solution sterilizes the implant pocket to prevent infections. Dr. Yoho is batting 1000 on this record—he can gratefully say that he has not seen a single infection from this procedure. In addition to dangerous infections, minor infections are thought to contribute to the danger of a complication called capsular contracture, or hardening of the breast around the implant. So the antibiotic solution might help to prevent this complication as well.

Next, Dr. Yoho puts a long-acting local anesthetic right inside the implant pocket. Having a local inside the breast has a painkiller effect in the area for up to 8 hours after surgery. This is important so that the patient has plenty of time to take her pain pill after waking up. This keeps the post-op pain to a bare minimum.

Now, it is time to place the actual implants. The tiny incision does not allow for a filled implant to be pushed through the belly button. So the empty implant is placed through the small tunnels under the skin while it is rolled up (like a taquito, as Dr. Yoho describes it). These are threaded up to the breasts using a “no-touch” technique. This technique doesn’t mean that Dr. Yoho operates with a “Look ma, no hands!” kind of recklessness. It means that, although he does use hands, the implant and the patient are both wetted down with the antibiotic saline solution so that all surfaces are sanitized as the surgeon is working. After the implants are in place, they are then filled with sterile saline.

Once the implants are placed and filled, Dr. Yoho sits the patient up. This is to check the evenness of the breasts and the appearance (because we don’t look the same sitting or standing as we do lying down). Although, just like natural breasts, implants are rarely if ever perfectly even, Dr. Yoho checks and adjusts the saline levels to make sure they are as symmetrical as possible. Once the desired levels are reached, Dr. Yoho tugs out the fill tubes. The implants have a valve that self-seals once these tubes come out.

After the tubes come out, your surgery is basically finished. Your breasts will immediately be wrapped with a light elastic bandage to help prevent swelling. A sports bra is placed over this, and an elastic band is placed above the breasts. You will also have a small dressing covering the little belly button incision.

By the time this is completed, you will be awake. Your family or friends can then come in and see you in recovery.

Part 3 will cover the surgical recovery.

What Is it Like to Have No-Scar Breast Implant Surgery: Part 1

Do you know what TUBA is? No, not the musical instrument. It’s actually a kind of cosmetic surgery. TUBA stands for Trans-Umbilical Breast Augmentation. This surgery actually puts in the breast implants through an incision in the belly button (also called the umbilicus). This way, there is no scar in and around the breast after the breast augmentation surgery. This surgery is favored by Dr. Yoho for its safety, speed, accuracy, and for the no-scar results. Well, to be specific, there is a scar, but it’s inside the belly button-not an area that most patients worry about. Dr. Yoho has successfully performed TUBA method surgery thousands of times.

Transumbilical breast augmentation has many advantages over standard approaches for the right patient. Patients experience less downtime and need less post-operative care. So who is the right patient? Good candidates desire larger breast or need breast reconstruction. Good candidates for TUBA also do not want or need a breast lift in addition to breast augmentation, and have good skin elasticity (relatively tight skin). Finally, as with other surgeries, candidates should be in good physical and mental condition (no active diseases, disorders, or mental instabilities).

So, how can breast implants be placed through the navel?

If you were to have TUBA surgery, you would probably be on the operating table for less than an hour. In fact, typical transumbilical breast augmentation takes as little as 20 to 30 minutes. You could have either general anesthetic (which knocks you out), or local anesthesia with IV sedation. Dr. Yoho has long used this special light sedation method to reduce patient side effects from anesthesia. Although the patient is awake during surgery, they are given relaxation medicine and usually don’t remember anything.

But we’re getting ahead of ourselves. The first step would be a consultation to evaluate you as a candidate. Then you would decide on the size of your implants. You will try on some different outfits with bra implants to see how you feel with different sizes. Dr. Yoho will also help you to evaluate sizes in terms of your body frame and current breast shape and size. When you go in on the day of surgery, you will once again talk to Dr. Yoho about the implant sizing, and he will mark your body in preparation for the surgery. The lines that cosmetic surgeons draw on patients’ bodies are like a diagram for the operation, partly because bodies look different lying down than standing up. In the case of TUBA, the lines show where the tunnels will go from your belly button to your breasts. You will then be taken to the operating room.

You will be sedated and prepped for surgery. You will receive local anesthetic around the breasts and around your belly button area that will help reduce soreness in post-op and reduce bleeding during surgery. Then, the actual incision is made in your navel. Dr. Yoho carefully separates the tissues around the navel, which helps to prevent the formation of scar tissue. Dr. Yoho thinks that this is one of the advantages of his extensive experience: doctors with less experience might not do this.

Next, a device is threaded inside the incision that creates a tunnel between the navel and each breast. These tunnels are done with a blunt device and not with a knife. In other words, there is no cutting or slicing of tissue in the tunneling procedure. Pockets are also created in the breast area to hold the implant. Dr. Yoho will consult with you before the procedure about his placement (under or over the muscle) of your breast implants.

Next, a tube is run up to the breast with a balloon-expander device. This is inflated until the tissue is taught so that the pressure slows or stops the bleeding, and also finishes the space inside so that the implant will rest easily and naturally after surgery.

Next week: part 2.

How to Approach Your Breast Sizing For Your New Implants

Do not focus on the exact implant size! Instead, put the sizer implant in a bra and see how it looks on you…

Everything depends on how you look with the given style and shape and size of your implants. The “high profile” implants should be tried and compared with the other styles. Do not look at the “before and after” pictures, as they are irrelevant. Examine how you feel with the different looks and the different implants. Take home the sizer implants if possible and try them on with different bras (Dr. Yoho’s office offers this). Your surgeon will help you with what’s reasonable for your body style, chest size and breast characteristics. Listen carefully to all the information available at the office; there are important aesthetic and health issues involved.

Dr. Yoho likes under-the-muscle implants for many cases in which the patient has substantial breast tissue. These often look absolutely fabulous right after the procedure, and can’t get “hung up” under the muscle and “ride high.” When the breasts aren’t too saggy, inserting the implants through the armpit is a very nice approach which can give very satisfying results. With the “under the muscle” approach, however, you do risk eventual implant displacement and movement, and the procedure requires eliminating the lower part of the chest or “pectoralis” muscle during the surgery. But if there’s very little breast tissue, the implant should generally go under the muscle, using the “through the belly button technique” which works nicely for many patients. These are all big decisions to make, and the patient should read as much as she can and learn as much as possible from the surgeon in order to obtain the best result.

Everything You Wanted to Know About Breast Implants but Were Afraid or Ashamed to Ask

Seattle Port at Night

Did you know that the most important factor in predicting your result with breast implants is the type of breasts you have before the surgery? I always check the breasts and make sure that we don’t have an unusual problem. Some breasts are very, very saggy and need a lift before doing implants. It used to be that the surgeons generally performed the lift and the implant at the same time, but opinion is shifting on this issue because the complications are so high if these two procedures are performed together. All kinds of problems, including nipple areolar area skin death, occur. And the general opinion now is that it’s better to do a lift in one procedure and wait four to five months before inserting an implant, if necessary.

Other breasts are different than the “standard model.” Some breasts are long and skinny, and these breasts deserve special treatment before performing the implant. Sometimes they need a reduction. Sometimes they need a procedure that makes them look more like normal breasts before doing the implant.

Another problem is the question of a person with slightly saggy breasts who might not want scars on her breasts. In this case, we offer a lift first, but many of these individuals like a fairly large implant, and this will lift the nipple to some degree. They accept a somewhat more “natural” look, which is a little bit saggy, rather than having scars on their breasts. We frequently insert these through the armpit, through an incision which for saline implants is only about an inch long or less.

There are many breast augmentations that are performed above the muscle and many that are performed below the muscle. The theory about the above-the-muscle implant is that it produces a smoother upper curve of the breast. However, if you have rather reasonably full breasts that aren’t too saggy, an over-the-muscle implant is much easier recovery process and produces a very predictable result in our hands. Additionally, below-the-muscle implants over the long term may produce several undesirable effects. These include the breast falling off of an implant that is riding high under the muscle, and while this is acceptable in some cases, in others it’s not. A second complication which is very common is over the two to three years after getting your implants below the muscle, the activity of the muscle pushes the implant down and out. So the implants become saggy sooner rather than later.

We always recommend good bras for our breast implant patients, and in particular, we like Bali brand “Minimizer” bras, which have broad straps and full support and full coverage. Stretchy, “sports-type” bras are generally not as good because they just don’t supply the support, even though perhaps some manufacturers and individuals think that they’re very supportive.

Each breast project is an individual effort based on your particular idea of the size that you want, and we size you very carefully in the preoperative period. Your breasts also determine what kind of result you’re going to get, and the surgical technique also is very important. We perform breast augmentations through the belly button, under the muscle, through the armpit, above the muscle, and also use areolar incisions at times where this is the best option or the patient wants this. The crease at the bottom of the breast can also be used as an entry point to insert the implant. However, this is probably less desirable in many cases because the scar is visible in a lot of situations.

So your consultation will take you through the process and we will check the size you want, tell you the limitations that exist because of your breast type, and make a recommendation based on your individual needs and desires.

Breasts Are All Different, So You May Need a Special Procedure To Make Yours Look Better

Mt Rainier February 2012-by Dr. Yoho

By: Robert Yoho, M.D.

Putting an implant in your breast is not always the answer to give you a better breast look. Implants work beautifully for breasts that are generally formed well, but in some cases shouldn’t be used at all, and in other cases should be used after a primary surgery to get the breasts in a shape that can accept an implant and stretch out over the implant properly and produce a normal-looking, round, pleasing breast. 

Note that many of our patients like different looks in their breasts. Some patients like rather large breasts and they don’t mind having a bit of a demarcation in the upper pole of the breasts. Others don’t like this look at all and want a much more sloping look. Different effects can occur based on whether you have a lot of breast tissue or very little breast tissue and whether the implant is placed above or below the muscle. 

Other people have breasts which are different than the average, such as long, narrow breasts, which are called “tubular” breasts, and these need special treatment. The general pattern is to do a special reconstruction surgery or lift and then four to six months later use an implant if needed to create a larger volume breast. A little bit of volume can be added with fat transplant, but this is nowhere near the volume which is possible with implants.

The practice of putting an implant in along with a breast reconstruction at the same time adds so many variables that very few surgeons can do this with any degree of predictability. Indeed, one of the most famous breast surgeons in the country wrote an article saying that this should never be done and that all breast reconstruction should be done prior to implant placement, which should be delayed at least four to five months. He showed pictures of his own cases where the whole nipple areolar complex had died during the process of attempting to put the implant in and reconstructing the breast at the same operation on the same day.

So we need to evaluate you individually. Your breasts are a certain kind of project; it may be a complex project or it may be an easy project, but please come in for your own complimentary consultation and we’ll tell you exactly what to expect. Note that every breast operation has the risk of imperfection in its results, but things can almost always be improved by a secondary procedure or even a third procedure. We have performed breast reconstructions where we haven’t “gotten it right” until the third procedure, and the patients have been very good about letting us continue to operate at intervals of four months. In many of these cases, the patients end up with a very satisfactory result and breasts that look fantastic compared to their breasts preoperatively.


Breast wishes,

Robert Yoho, M.D.

The "Gummy Bear" Implant is a Failed Implant

Unrelated to Gummy Bears or implants

The claim with the gummy bear implant is that if ruptured, the silicone on the inside will not bleed into the surrounding tissues. This is a patently false proposition, because those of us who have taken out gummy bear implants which have been ruptured have seen the silicone spread in just exactly the same way that a gel implant or an ordinary silicone implant's contents will leak out of the implant shell. So therefore this is not an advantage. 

The other advantage claimed for the gummy bear implant is the lower capsular contracture rate. This is a falsehood, because the gummy bear implant is naturally as firm as if the patient already had a Class II capsule or a quite firm breast. Therefore, the Class II capsules aren't counted in the statistics, and this distorts the perception in the studies that the gummy bear implant is superior. 

We think the gummy bear implant is too firm to be very natural and not a good choice in general for anyone. We like gel implants. We don't believe they have a higher capsule rate than saline implants, and their only problem is their expense. A new device that allows us to put them in more easily and damage them less is a great help to their placement. This is the "Keller Funnel", and we have had a great deal of satisfactory experience with it in easing the insertion of our implants, using a smaller incision for the implant's placement, and lowering the chance that we will distort the implant shell in some way, thus leading to a higher chance of rupture later in the patient's history. 

Please feel free to come in for your consultation in Los Angeles or Visalia in regard to these issues and chat about the various options in regard to silicone and saline implants.