Questions to Ask Your Surgeon

Am I a candidate for a dual-plane breast augmentation?

With the dual-plane approach, the implant is under the muscle, yet the muscle is released or moved out of the way so the implant can settle into the bottom half of the breast, filling it in a more natural way. This technique tends to be Dr. Rahban’s preferred approach. Note that there are varying degrees of dual plane and this depends on your anatomy and your surgeon’s experience.

How do you help me determine which size is right for me, both cosmetically and physically?

During surgery, he has a full array of sterile “sizer” implants. He inserts a sizer and sits the patients up, continuously comparing them to the photos they selected. He will exchange sizers until he is confident that the size is consistent with the desired look--not cup size--the patient desired. As such, he is not bound by a limited number of implants he pre-selected or worse, what the patient thought was the appropriate size during the consultation. With this time consuming but thorough method, Dr. Rahban has virtually eliminated sizing issues in his practice.

Do you sit me up during surgery so you can see how the implants sit?

At this point, he will refer to the photos you have given him, and will insert the size of implant he believes will accomplish the goal. He will then sit you up while you are asleep and look at the photos and compare to determine if the size is correct. If need be, he will repeat this procedure with various sizers until he feels confident that your size is consistent with what you selected, and that both breasts are symmetrical in size.

Do you use a Keller Funnel?

When inserting the implant, especially silicone implants, the implant is large and the opening is small, requiring force to insert the implant into the pocket. This jeopardizes the integrity of the implant, and often causes damage to the skin of the incision. Dr. Rahban uses a product called the Keller Funnel™ which is a device that facilitates the insertion of the silicone implant into the pocket with great ease.

Do you close my incision or does someone else?

In closing the incision, Dr. Rahban carefully sutures each underlying layer from the inside out, maximizing support. It is crucial that your surgeon personally closes both breasts, as there are some plastic surgeons who allow a surgical tech or surgical assistant to close.

Tell me about your closing technique.

In closing the outer skin, Dr. Rahban uses an enormous number of sutures. This high number of sutures ensures there is very little tension on each individual stitch. This lack of tension produces minimal scarring, and the incision is virtually invisible once the healing process is complete.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After a breast augmentation, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.

Do you mark my breasts prior to surgery or do you wait until I am lying down?

The most crucial step in a breast lift is marking the breasts prior to surgery. The markings will determine how well the surgery is performed in terms of symmetry and overall shape. Some physicians do the markings during the surgery. However, Dr. Rahban finds this to be incredibly inaccurate, as patients are lying down and their breasts are not sitting naturally.

Do you double check your markings to make sure they’re accurate? Am I sitting up while you do this?

Next, prior to making any incision, Dr. Rahban likes to confirm that the markings done preoperatively are accurate. Therefore, with the patient asleep, he will temporarily staple his markings into place and sit the patient up, looking at each breast for its own shape as well as symmetry between the two.

Am I a candidate for a dual-plane breast augmentation?

With the dual-plane approach, the implant is under the muscle, yet the muscle is released or moved out of the way so the implant can settle into the bottom half of the breast, filling it in a more natural way. This technique tends to be Dr. Rahban’s preferred approach.

How do you help me determine which size is right for me, both cosmetically and physically?

During surgery, he has a full array of sterile “sizer” implants. He inserts a sizer and sits the patients up, continuously comparing them to the photos they selected. He will exchange sizers until he is confident that the size is consistent with the desired look--not cup size--the patient desired. As such, he is not bound by a limited number of implants he pre-selected or worse, what the patient thought was the appropriate size during the consultation. With this time consuming but thorough method, Dr. Rahban has virtually eliminated sizing issues in his practice.

Do you sit me up during surgery so you can see how the implants naturally sit?

At this point, he will refer to the photos you have given him, and will insert the size of implant he believes will accomplish the goal. He will then sit you up while you are asleep and look at the photos and compare to determine if the size is correct. If need be, he will repeat this procedure with various sizers until he feels confident that your size is consistent with what you selected, and that both breasts are symmetrical in size.

Do you use a Keller Funnel?

When inserting the implant, especially silicone implants, the implant is large and the opening is small, requiring force to insert the implant into the pocket. This jeopardizes the integrity of the implant, and often causes damage to the skin of the incision. Dr. Rahban uses a product called the Keller Funnel™ which is a device that facilitates the insertion of the silicone implant into the pocket with great ease.

Do you close my incision or does someone else?

In closing the incision, Dr. Rahban carefully sutures each underlying layer from the inside out, maximizing support. It is crucial that your surgeon personally closes both breasts, as there are some plastic surgeons who allow a surgical tech or surgical assistant to close.

Do you use layered closure?

Closure of incisions can be as simple as staples and/or glue, and as complex as a multiple-layered technique. Dr. Rahban feels strongly that closing the skin with multiple layers in a fastidious fashion is the single most important step in having scars that will be minimal and that will ultimately fade over time.

Tell me about your closing technique. How much tension is placed on the incision?

In closing the outer skin, Dr. Rahban uses an enormous number of sutures. This high number of sutures ensures there is very little tension on each individual stitch. This lack of tension produces minimal scarring, and the incision is virtually invisible once the healing process is complete.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After a breast augmentation with lift, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.

Do you mark my breasts prior to surgery or do you wait until I am lying down?

The most crucial step in a breast lift is marking the breasts prior to surgery. The markings will determine how well the surgery is performed in terms of symmetry and overall shape. Some physicians do the markings during the surgery. However, Dr. Rahban finds this to be incredibly inaccurate, as patients are lying down and their breasts are not sitting naturally.

Do you double check your markings to make sure they’re accurate? Am I sitting up while you do this?

Next, prior to making any incision, Dr. Rahban likes to confirm that the markings done preoperatively are accurate. Therefore, with the patient asleep, he will temporarily staple his markings into place and sit the patient up, looking at each breast for its own shape as well as symmetry between the two.

Do you use layered closure?

Closure of incisions can be as simple as staples and/or glue, and as complex as a multiple-layered technique. Dr. Rahban feels strongly that closing the skin with multiple layers in a fastidious fashion is the single most important step in having scars that will be minimal and that will ultimately fade over time.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After a breast lift, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.

Do you use the superiomedial pedicle technique or do you use a different pedicle?

The superiomedial pedicle technique preserves the most crucial breast tissue located in the upper pole or upper chest. The most common aesthetic complaint among women with large, sagging breasts is the lack of breast tissue in their upper chest with excess in their lower chest. The superiomedial pedicle technique utilizes this upper tissue to preserve the blood supply to the nipple, whereas the inferior pedicle technique removes the upper tissue, with preservation of the blood supply from the bottom.

What is my insurance company’s minimum reduction requirement? Will that be too much for my breasts?

Cautionary note: Make sure that your breasts are not over-reduced in an effort to meet insurance guidelines. Many insurance companies have strict volume reduction requirements in order for you to qualify. Some doctors may remove too much breast tissue in an effort to meet these requirements, leaving patients with breasts that are now too small.

Will your proposed volume reduction keep my breasts proportionate in their individual dimensions?

Often, patients will tell their surgeon that they would like to be a small C, and to their dismay, when the swelling settles and 6 months have gone by, their breasts look wide and flat, not small and round like an attractive breast. This is the result of over-reduction.

Will you reduce my breasts with a consideration for shape, not just size?

In many cases, breast reductions are considered solely from a size perspective and aren’t approached with the same aesthetic consideration as other cosmetic procedures. Doctors may feel that a patient with smaller breasts will be happy irrespective of the shape, as the primary goal is reduction in volume. However, without proper markings, patients may find their breasts are boxy or misshapen after breast reduction surgery.

Do you make the markings while I’m standing up or while I’m lying down?

Some physicians feel they can do the markings during the surgery. This may lead to incisions that are longer than necessary, leading to one of the most common complications, which is a visible scar within the cleavage and the axilla or armpit. Doctors who try to do their markings on the table don’t have the benefit of a standing patient to guide them.

Do you sit me up during surgery to ensure the proper size and symmetry?

In the operating room, patients’ arms should be safely secured on arm boards, allowing them to be safely sat up during surgery. One of the main methods to ensure accuracy and attractive outcomes is sitting the patient up multiple times throughout the surgery. While this may take extra time for a physician, this critical step allows for him to see the progression of his breast reduction and create symmetry.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After a breast reduction, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.

What is my exact diagnosis? How will you fix it?

With a vast amount of experience with breast surgery, Dr. Rahban has seen all types of breast complications. The key with breast revision is correct diagnosis. Your surgeon must know what the problem is in order to give patients the correct options. As the breast tissue is no longer 100% normal, it is unforgiving and therefore an error in diagnosis will lead to a very poor outcome and make further revision even more difficult.

Will my breast revision require the use of extracellular matrix?

Extracellular matrix (ECM) is tissue from other sources, removed of all its cellular components, leaving behind a matrix or scaffolding of tissue. Your surgeon needs to be familiar with not only the various ECM products, but also how to use the material effectively. Unfortunately, this material is still quite expensive, and therefore should only be used when truly necessary.

If I have capsular contracture, will you perform a complete capsulectomy?

The correction of capsular contracture requires either a capsulectomy or capsulorrhaphy. Dr. Rahban’s preferred approach is a complete capsulectomy. This involves removal of the entirety of the scar tissue, hence creating a brand new pocket without any of the old scar tissue.

In getting rid of scar tissue, will you use a multi-layered technique so I’m not just left with another scar?

Unfortunately, unsightly scars are a very common problem following breast surgery. All too often, patients are told that the cause for their unsightly scars is their poor healing, when in reality it was due to poor closure. In this instance, your surgeon would need to excise all of your scars and re-suture them using a multi-layered closing technique.

If I’m reducing my implant size, will you also lift my breasts?

Correction of large implants may involve not only exchanging to a smaller implant, but may necessitate some type of lift procedure. When an implant is downsized significantly, the breast is left with excess tissue that, if not addressed with some type of lift, would lead to sagging.

Are you familiar with the neo pocket procedure for my symmastia or lateral displacement?

In order to correct symmastia, double bubble or lateral displacement, there is a new and advanced technique called a neo pocket procedure, whereby your surgeon will create a new implant pocket above the old capsule that is smaller to accommodate the actual size of the implant.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After a breast revision, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.

What technique do you use for inverted nipple correction?

Because inverted nipples are usually caused by some kind of tethering, the corrective surgery usually involves releasing the fibers that keep the nipples inverted. This begins with an incision at the base of the nipple to access the ducts or fibrous tissue that is holding the nipple down. From there, tissue is rearranged in order to allow for improved nipple projection. Finally, the incision is closed with precise sutures that create minimal scarring.

What does your surgeon do to maintain the erect position during the healing process?

Special care is then taken to maintain the nipple in the erect position during the healing process. Dr. Rahban uses a special technique to keep them projected. This is crucial, as the nipple has a tendency to retract during the early healing phase.

What technique will you use to reduce my nipples?

Most commonly, Dr. Rahban addresses enlarged nipples by using a telescoping technique, in which he removes redundant tissue at the base of the nipple, allowing him to set back the nipple into the areola. With this approach, the nipple retains sensation and breast milk production. If a nipple is too large, another technique called the transecting technique whereby the nipple is reduced from the top down. With this technique, sensation and breastfeeding may be altered.

What’s your technique for reducing the areola? Will you be using a permanent suture around my areola?

In reducing the areola, Dr. Rahban makes an incision around the areola in the size that he would like. He then makes a second incision around the residual pigment that is larger than the desired areola. He then removes the intervening pigment and subsequently close the outer incision using a pursestring technique. This allows the overall size to be significantly smaller. If the reduction is significant, it is crucial that a permanent suture be used to perform the pursestring closure. Otherwise the areola will stretch with time and can become much larger than when it began.

Do I have enough extra skin on my flanks that I require an extended tummy tuck, or is a standard tummy tuck sufficient?

In many cases, pregnancy can cause a buildup of loose, excessive skin that extends beyond the abdomen. When loose skin can be seen on the flanks in addition to the tummy, an extended tummy tuck is the correct procedure to eliminate excess skin and tighten the underlying musculature.

Will the length of my incision fully address all excess skin?

A tummy tuck is not about the length of the incision, but rather the contour of the abdomen. A shorter scar with poor contours is not better than a slightly longer scar with smooth and beautiful contours.

Will my tummy tuck include mons rejuvenation?

Dr. Rahban will rejuvenate the pubic area and the mons. Plastic surgeons will often ignore the pubic region, leaving it sagging and puffy. They only rejuvenate the abdomen and reattach it to a puffy mons. With every single tummy tuck, Dr. Rahban rejuvenates the mons or pubic region. He removes excess fat from underneath the mons and removes excess skin. He then lifts up the mons and re-secures it to the abdomen, creating a younger looking pubic area.

Do you close my incision or does someone else?

At many cosmetic surgery facilities, the surgeon allows another person to close the patient. This is not the case with Dr. Rahban—he doesn’t let anybody else touch his patient.

Do you use layered closure?

In closing the incision, Dr. Rahban employs layered closure. He starts from the bottom and meticulously closes each individual layer of tissue outward to the surface skin. By properly aligning the layers from the inside out, he ensures there is no depression on the resultant scar.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After a tummy tuck, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.

Do I have rectus diastasis? Is it severe enough that I need a standard tummy tuck or is a mini tummy tuck sufficient?

As the belly expands during pregnancy, it does not only affect the outer skin—it also stretches the underlying abdominal muscles, known as the abdominal fascia, hence creating rectus diastasis. When this occurs, the muscles tend to bulge outward, creating a pooch and unflattering appearance. That being said, during a mini tummy tuck, the muscle separation is not often addressed.

During my mini tummy tuck, will you tighten my stomach muscles below the belly button only?

If you address only the bulge below the belly button and not the bulge above the belly button, you will have a weird pooch above the belly button, creating an uneven appearance. If a patient has a significant muscle bulge, a full tummy tuck is necessary to get access to the entirety of the abdominal muscles.

Which part of my abdominal skin is being removed? Will that fully address my stretch marks?

When it comes to the stomach, stretch marks are an extremely common problem. There is no treatment that has been proven to reduce stretch marks, beyond surgical removal of the offending skin. If your stretch marks fall within the area being excised, they will be removed.

Do you close my incision or does someone else?

At many cosmetic surgery facilities, the surgeon allows another person to close the patient. This is not the case with Dr. Rahban—he doesn’t let anybody else touch his patient.

Do you use layered closure?

In closing the incision, Dr. Rahban employs layered closure. He starts from the bottom and meticulously closes each individual layer of tissue outward to the surface skin. By properly aligning the layers from the inside out, he ensures there is no depression on the resultant scar.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After a mini tummy tuck, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.

Will the length of my incision fully address all excess skin?

A tummy tuck is not about the length of the incision, but rather the contour of the abdomen. A shorter scar with poor contours is not better than a slightly longer scar with smooth and beautiful contours.

Do you close my incision or does someone else?

At many cosmetic surgery facilities, the surgeon allows another person to close the patient. This is not the case with Dr. Rahban—he doesn’t let anybody else touch his patient.

Do you use layered closure?

In closing the incision, Dr. Rahban employs layered closure. He starts from the bottom and meticulously closes each individual layer of tissue outward to the surface skin. By properly aligning the layers from the inside out, he ensures there is no depression on the resultant scar.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After a tummy tuck, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.

Will my tummy tuck include mons rejuvenation?

Dr. Rahban will rejuvenate the pubic area and the mons. Plastic surgeons will often ignore the pubic region, leaving it sagging and puffy. They only rejuvenate the abdomen and reattach it to a puffy mons. With every single tummy tuck, Dr. Rahban rejuvenates the mons or pubic region. He removes excess fat from underneath the mons and removes excess skin. He then lifts up the mons and re-secures it to the abdomen, creating a younger looking pubic area.

Is my skin elasticity good enough to receive liposuction only?

Liposuction candidates should have good skin elasticity, which will allow it to conform to the new, slimmer contours. If this is not the case, liposuction will not only produce zero improvement, but it will also make you look worse, as the fat underneath the skin is what’s holding the skin tight. When the fat is removed, semi-loose skin will become very loose skin.

Do you use multiple access points during liposuction?

The key to liposuction is using multiple access points, rather than one. While at first patients are concerned about the number of incisions, it’s more important that the target area get addressed from multiple areas so the contour is smooth.

Do you use a basket cannula to equalize the fat?

After Dr. Rahban is done removing the fat, he goes back with a special cannula called a basket cannula that equalizes the remaining fat. Because fat is solid or semisolid, it is removed in globules rather than a flowing stream. The remaining fat doesn’t naturally fill in the removed globules. By breaking up the remaining fat with the basket cannula, Dr. Rahban helps it to settle in a natural, even contour.

Do you leave behind a superficial layer of fat?

In order to accomplish smooth contours, you need to leave behind an upper layer of fat that’s been untouched. The fat is generally divided into superficial and deep layers. The fat in the deep layer is the fat that should be removed, leaving behind the superficial layer untouched as a buffer so your skin looks smooth.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After liposuction, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.

I understand the labia are very malleable. Are you careful in marking them so they’re not over-resected?

The labia will be marked prior to any infiltration of local anesthetic. The markings are the most crucial element. Since the labial tissue is stretchable, the biggest error with labiaplasty is over-resection. Surgeons may pull too hard on the labia when marking, therefore thinking there is more tissue than there actually is.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After a mini tummy tuck, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.

How do you perform c-section revision?

In removing a c-section scar, Dr. Rahban must remove all scar tissue down to the level of the muscle. He does this by undermining the scar itself, ensuring that all unsightly tissue is excised, leaving behind only healthy, fresh tissue from which to work.

Do you use layered closure?

In closing incisions, Dr. Rahban meticulously closes the incision from the inside out, ensuring each underlying layer is perfectly lined up and evenly sutured together. As a result, the scar from Dr. Rahban’s incision is virtually invisible, requiring no further revision. This procedure generally takes an hour to perform.

Do you offer a second consultation prior to my procedure?

Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.

How many follow-up appointments do we have?

After a tummy tuck, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.