What Are My Chances of a Complication After Breast Surgery?

Vacation photo by Dr. Yoho

Breast surgery recovery is relatively predictable, but the most important predictor of an individual’s surgical result is their psychological and physical preparation before the surgery. Their breast shape and size often dictates how good a result can be obtained, and although we can make great improvements in many cases, certain breasts are just very difficult to make perfect. In particular, patients with long, skinny breasts or very droopy breasts require fairly extensive surgery which is significantly less predictable than just inserting an implant. Additionally, we absolutely refuse to put an implant in at the same time as a breast lift is performed. The implant pushes out on the repaired area while the little stitches and the tissue try to heal and hold the breast implant in. This is a recipe for repeat surgeries, and there are a significant number of articles in the medical journals that recommend that breast lifts not be performed at the same time that an implant is inserted. 

The complications that occur with breast surgery include about a five percent rate of hardening or capsular contracture over the life of the implant. If this happens, you need to report back to us as soon as possible, because there are medical ways to treat it. 

Other potential complications include: infection, but this has a very low rate at less than one percent; blood buildup around the implant which might need to be taken out within a few days, and variations in shape and position that may be related to the surgery or it may be related to the shape and size and contours of the pre-existing breast. 

Touchups are just a few percent of what we do, but if we consider the result imperfect and a touchup appropriate, we do breast touchups at no charge. Come in and see us for a free consultation.


Breast wishes,


_________________________
Robert Yoho, M.D.

What to Watch For After Your Breast Surgery

One of Dr. Yoho's children during a beach vacation

First, the surgeon may have taped areas of your breast or given you a special bra or binding to wear after your breast implant. We generally use an elastic dressing which should be removed at 24 hours, and a bra should be applied or the bra which is underneath the elastic should be left on. Checking on the breasts at 24 hours is always desirable, because one of the rare complications of breast implant surgery is blood buildup around the implant, and sometimes this has to be removed within a few days to prevent a breast capsule or hardening.

We always emphasize the following in follow-up visits: First, good support bras are exceedingly important and we really like the Bali Minimizer bra for this. There are some exceptions, so some women need to wear no bra or a bra that doesn’t offer much support for the initial period after the breast surgery.

Secondly, we recommend 800 IU of Vitamin E each day taken orally, which can be purchased at any health food store. This should be taken indefinitely and may significantly decrease the chance of hardening or capsular contracture of the breast. We also believe fish oil is a great boon to decrease inflammation and also decrease the chance of capsular contracture. We recommend a teaspoon of liquid fish oil a day, which is the equivalent of four to five of those large fish oil 1,000 mg pills taken with food, and sometimes we recommend more if the patient is starting to have trouble with a capsule for short periods of time. Note that you can buy this on vitacost.com and we recommend several brands, including Carlson’s or Nordic Naturals or Eskimo brand fish oil, all of which have very little fishy taste.

Breast wishes,

_______________________________

Robert Yoho, M.D.

Does Dr. Yoho Touch Up Other Surgeons’ Cosmetic Surgery?

Dr. Yoho loves to visit Yosemite with his family

We are happy to have a look at problem surgeries. Sometimes patients lose faith in their surgeon due to a surgical complication or sometimes due to inexpert work or personality problems. We are happy to evaluate these people on a case-by-case basis and as long as your attitude is good and you don’t have an unreasonable expectation about your result, we’re happy to help. Note that in some cases it may be tougher to get quite as good a result in the secondary case as if we operated to begin with, because of scarring issues or healing issues and sometimes because of psychological issues. We work hard on surgeries such as “tummy tuck tune-ups,” which involve liposuction of the appropriate areas surrounding a surgery which was originally a tummy tuck. Some people have weight gain after liposuction or tummy tuck, and these cases can be improved a great deal also. We also have the ability to touch up the “pixie ear” of a facelift which has been inexpertly performed. Sometimes this involves a small touch-up facelift, and the general rule of thumb is that waiting at least four to six months after the prior surgery is the best policy. The cases that are even farther from the original surgery than this, that is, several years afterward, sometimes react even better to the touch-up surgery, because the tissues have had time to completely mature. 

The rule of thumb in soft tissue work is that four months is a minimum before a repeat surgery is done in general. However, we believe that healing processes, especially in darker skins, can go out a year or more. In orthopedic surgery, or bone surgery, just as a matter of interest, the healing curve is two years or even longer. Dr. Yoho has experienced this himself with his own adjustment to a foot fracture which is much better at three years than it was at two years.

But in any case, please feel confident to have a free consultation at Dr. Yoho’s office for other surgeons’ work and we’ll see if we can improve things. And we’re happy to give opinions about what we think would be beneficial or how improvement might be best effected.


__________________________



Robert Yoho, M.D.

The Biggest Misunderstanding Regarding Weight Loss

Dr. Yoho has been an observer of the weight loss/large volume liposuction scene for many years, and he’s also an aggressive amateur athlete who is well past his days where he was very accomplished in anything. In any case, he has some observations regarding diet and exercise that he’d like to share. 

The biggest misconception about diet and exercise is that the exercise is the critical component. Diet is much more important, and especially with women, any attempt to lose weight with just exercise without regarding the diet carefully is doomed to failure. There are some men that can tolerate heavy exercise and be successful at weight loss and ignore their diet; however, these individuals often get injured at “boot camps” and other excessively aggressive exercise regimens. One of the fittest and best muscled individuals known to Dr. Yoho, a semi-professional body-builder, exercises at his body-building only about four days a week for a half an hour. That said, his diet is what Dr. Yoho calls the “Nazi Diet.” He never has a cupcake to save his life, never eats any chocolate, and never eats any refined sugar of any kind. He restricts himself to what would be regarded as very strict health food.

The other misconception is that diet pills and injections are a smart idea. While these can help in the short term, the long-term issue with them is well known, that is, recurrence of the weight problem.

Of course, the long-term results of gastric bypass surgery of any kind are unknown and probably much worse than the proponents (who have an enormous financial conflict of interest) would tell you.

What Dr. Yoho does recommend heavily is “programmed diets” such as Jenny Craig and others, which give you the food and portion-control your consumption by showing you exactly what it is to eat just the right amount and the right composition of different foods. These, while not easy, do have the potential for long-term success and long-term training of the individual. Dr. Yoho himself uses a form of a programmed diet and buys his meals that he eats during the week from SterlingCuisine.com, a local food service that gives him excellent nutrition at a reasonable price.

I’m Under Thirty Years Old or I Look Under Thirty Years Old:

What can Botox, facial fillers, and facial cosmetic surgery do for me?

Unrelated to medical spa services!! Dr. Yoho's daughter after a gritty race.



We frequently work with people who look absolutely great before we start with them. For these people, looking fantastic is the goal. Many options are available. Facial fillers, especially in the lips, are quite popular. Cheek implants can give exotic looks to people whose faces look good to begin with but not extraordinary. Botox elevates the brows even in an individual with no wrinkles because it relaxes the muscles that ordinarily pull down the middle of the forehead and the side of the forehead, thus allowing the brow muscles to elevate the brows. This is a very pleasing look in young women. 

 So if you’re interested in looking your best, we have something for you. Even if you look great already.

All About Our Botox Expertise

Dr. Yoho relaxes in Argentina. The crowd behind him does not represent our Botox work!!

Did you know that Jeremy Romaine, P.A., who has worked with Dr. Yoho for over a decade, trains physicians in proper Botox usage? Our techniques are derived from the Carruthers, who pioneered Botox for cosmetic facial work. We’re doing what we believe to be the same dosing and application techniques that they use currently in their office. (And I might add, at prices that are probably three times ours.) The key to Botox is the proper quantity, and each of our patients gets about a half a bottle, which is a significant dose, and proper placement with no skimping in the proper areas and not overdoing the areas that should be left alone.

The thing patients enjoy the most about Botox is the brow arch, which is a natural occurrence of the numbing or decreased function of the muscles pulling down in the face, which have Botox injected into them. The frontalis, or muscles right above the eyebrows, are activated for some reason and these pull the eyebrows up and produce a very pleasing effect. The object is not to completely eliminate all the motion in the brow, but to get rid of the key wrinkles in the middle of the brow and at the sides of the eyes while allowing this arch effect to happen naturally.

Please come in for a free consultation with Jeremy and see what you can expect from your expert Botox application.

Dr. Yoho Performs Pure Local Anesthetic Liposuction Too

Dr. Yoho on the edge

Although most of our patients like some sort of light sedation, we can do breast augmentation, liposuction, and eyelid procedures with pure local anesthetic. We often will give a relaxation pill prior to this, but local anesthetic does the job, and if you’re a calm and relaxed individual who doesn’t want any intravenous medicine, we’re certainly happy to help you using the pure local anesthetic liposuction technique. A few of our patients choose this method, and we can make you perfectly comfortable with it. It does take a little bit of talking during the procedure and hand-holding, but pain isn’t a significant problem at all; in fact, most of our patients have no pain and are able to go home almost immediately after the procedure is complete. Please let us know if this is what you want and we’ll be happy to oblige you.