A Few Approaches and Considerations for Breast Implantation

Each breast implant procedure has drawbacks and advantages for different patients depending on the breast size desired, the patient's breast anatomy and the patient's chest size. One of the most important variables in this question is the patient’s breast volume. If the patient has a great deal of breast tissue, going over the muscle sometimes is the easiest and most comfortable way, and has the shortest recovery time. In most cases we do this through the armpit, using an incision of about half an inch in the highest area of the armpit. But when going through the belly button or navel, breast enlargement is usually performed underneath the muscle. Women with breasts that are not too saggy or are relatively small are the best candidates for this. Another general consideration is, if you have had children, your breasts will likely stretch out better to accommodate the implant.

Absolutely no scars in the breast area result from the belly button technique. The passageway is made from the belly button to underneath the breast muscle with a special instrument. Then, the pocket that the implant is going to rest in, is prepared and shaped with other instruments. A special “sizer” implant is placed and filled with air. Once the “sizer” implant is inflated, the pocket is further checked and shaped. The permanent implant is then rolled up like a little taquito, threaded through the small passageway and inflated with salt water. The patient is then checked while sitting upright. If everything looks good (e.g., the implants are centered under the nipples, and the space where the implant is appears to be just the right size), the tubes used to fill the implants are removed and the little valves on the implant automatically close. The belly button area is stitched up, and the patient experiences some drainage for about 24 to 48 hours.

Massage Therapy of Breast Implants and Breasts After Breast Implantation

On the beach in Trinidad

Most surgeons believe massage to be of critical importance after breast implantation, as it is thought by most to decrease the chances of firming of the breast or capsular contracture. We generally recommend massage, but it must be done in specific ways, so please discuss this with Dr. Yoho during your follow-up visits.

During the first few days after breast implantation, you do not have to massage your breasts because generally they are too tender. But if you can handle a little light massage, this will help you get the best results. The first object of massage is to keep the area above the implant open. In order to do this, you squeeze the bottom of the breast implant and breast with your thumb on one side and your fingers on the other, several times a day. Again, these techniques must be individualized, so if your breasts are taped up or you are in a special garment, don't massage it until after your first follow-up visit.

The other wonderful thing about massage is that you can reshape your breasts, particularly in the first few months after your implantation, with the proper massage. For example, in order to lower or increase the pocket in an area that seems to need a larger pocket, in other words, if there is a little flat area, pull up on the skin right next to the fold, push the implant down, and massage right along the fold with your other hand. We will demonstrate this technique in follow-up. If your fold seems too high on one side, you can lower the fold a bit by doing this type of massage. Examine the lower part of your breasts where the chest skin meets the upward swell of your breast, so you can understand the curve and how each breast is different, because they are always a little bit different. You can dramatically improve your breast implant results by the proper massage.

We also use a variety of support bras to improve the result. We strongly recommend that most patients wear bras continuously for the first nine to twelve months after the breast implant procedure. Many patients are a candidate for a properly fitting under-wire bra relatively soon after the surgery, but if you have an under-wire bra that sticks into your breast, that's not proper so please don't wear anything like this. If you're having discomfort, we want to know about it and see you as soon as possible. Please stay in close contact over the telephone and by coming in for your follow-up as directed in order to achieve the best results. Remember that your surgery is not done the moment you leave the office, because if you don't follow up and you don't follow our instructions properly, you may have breasts that hang too low, or have one breast higher than the other, or run into a variety of other complications. Rarely do we need to perform a second surgery to improve a result, and this is generally not necessary in a patient who is able to follow directions about bra wear and massage properly.

If My Breasts Are Uneven After My Implant Surgery, Can I Have a Touchup?



Dr. Yoho and Judy Yoho enjoying some time away from the office

These cases are very individual. Many times the breast implant surgery is a compromise between creating scars on the breast by doing more incisions, and having the best shape. Each case is its own animal, so to speak, and we need to carefully evaluate and do a lot of thought before touching up breast surgery.

That said, if your breasts are significantly uneven after our initial surgery, sometimes a simple procedure is all that is needed to make them closer to perfect.

Touching up breast implant always involves further risk of capsule formation or hardening of the breasts. This problem probably increases with every additional surgery on the breast, and additionally, careful attention must be given to the original approach to the breast implant to be sure that we’re not cutting off additional circulation to the breast tissue. The rule of thumb is that if it’s possible, we need to use the same incisions as were used originally. We view these cases as a challenge, and we need our patients to have proper expectations about this sort of surgery. Particularly, patients need to understand the idea that a second touchup might be necessary in cases like these.

Generally, the implants are changed out with new implants if the implant space is entered.

Most of this depends on you: Your psychological setup about your expectations, your level of perfectionism, but most importantly, just what your breasts look like and how much breast tissue you have to work with over top of the implant.

Breast wishes,


________________________
Robert Yoho, M.D.

What We Feel is Most Important for Breast Implants After the Operation

Today, Dr. Yoho brings you a two-for-one blog post

We emphasize the big three. Number one, support. Number two, fish oil. And number three, Vitamin E. 
 The support will help maintain the shape of the breast. The breast is sort of like Silly Putty, and it will gradually sag if not supported aggressively with the weight of the implant. Sometimes young people can get away with breasts that don’t sag so much for a while, but in the long run gravity catches up.

The other two things we emphasize after breast surgery involve prevention of capsular contracture. Capsular contracture or firming of the breast implant is the most common problem after breast surgery. We really think that Vitamin E is very helpful and have seen patients who weren’t taking their Vitamin E soften their breasts after starting just the Vitamin E. We recommend 800 IU a day in tablet form. This along with the fish oil can be purchased at vitacost.com.

Fish oil is now regarded as an excellent anti-inflammatory. Dr. Yoho takes it in large quantities himself for foot arthritis. We recommend a teaspoon of the fish oil a day and recommend the purified fish oil such as Nordic Naturals, Carlson’s brand or Eskimo brand fish oils. If you must take the capsules, you can take at least four a day, and if you actually have the start of firming of the breasts, Dr. Yoho may recommend a larger dose for a few months. 

Breast wishes,

 _______________________________



Robert Yoho, M.D.

The Advantage of Coming to See Dr. Yoho for Non-Invasive Procedures If You Are Prone to Anxiety

Did you know that because Dr. Yoho’s office is an accredited surgical center with AAAHC accreditation, Dr. Yoho has the ability to use intravenous medications for your more minor procedures as well as the major ones? We have patients that are scared of needles, which is a common phobia. We administer a little bit of relaxation medicine to these patients so they don’t feel anything at all during their Botox injections. Even for those who don’t have needle anxiety, we have reduced discomfort by using 32-gauge needles, which are the smallest needles commonly used in clinical practice. These can hardly be felt during administration of Botox. 

Additionally, we offer no extra charge sedation for our procedure with the fractionated CO2 laser, a procedure which has been popular and successful. You do need to bring a driver if you have sedation administered to you, but this is the only other requirement. We feel the risks are virtually nonexistent for the small amount of medication you’re given in order to accomplish these procedures in a way that’s pain-free and that erases memory of it. Additionally, you can use these procedures for fillers or any other minor surgical procedure if you are one of those people who is a bit anxious about discomfort. Lastly, we can get that intravenous line in your vein with no pain whatsoever in 90+ percent of the cases and in a fashion that most people won’t notice.