Dear Dr. Togba,

Q.  This Christmas my husband gave me a breast augmentation. We’ve discussed my getting implants before but have been concerned about achieving a proportional balance for my body type. Beyond that, will they look and feel natural?

 A. Giving plastic surgery as a Christmas gift becomes more popular every year; many spouses share the decision, the concerns, and the pleasing results. Natural looking results can be attributed to several things: proper implants, the surgeon’s experience, and understanding of placement for the patient’s particular body type. There are many variations of implants: anatomical round, teardrop, textured, and smooth. The choice depends upon the body type, the breast shape, and the patient’s preference. We have before-and-after photos at our office to help you visualize both the pre-operative condition and the realistic post-operative result before making a decision.

Dr. T

Q.  Can you place a breast implant through the armpit?

A. Dr. Togba. There are generally four incision choices for a breast augmentation: under the breast at the inframammary crease (where the breast meets the chest wall), through the nipple complex, through the belly button, or through the armpit. I prefer the armpit incision because no scars of any sort appear on the breast.

Dear Dr.Togba

Q.  I’ve been into your nice office and seen your patient counselor. Your pictures of breast augmentation results look very natural. Do you use different shaped implants?

A. Dr.Togba. There are many variations of implants: anatomical round, teardrop, textured, and smooth. The choice depends upon the body type, the breast shape, and the patient’s preference. How the implant is placed and positioned also impacts the final look. For most patients, especially those with minimal breast tissue, it’s best to position the implant underneath the chest muscles. This gives additional padding and a softer contour of the upper half of the breast. Your Plastic Surgeon should be experienced in many types of breast surgery and can help you achieve a natural looking result.

Q.  What implant materials are available?

 A. Dr.Togba. At this time, all breast implants are made out of a solid silicone outer covering and filled with either saline or silicone gel. Choosing between saline and silicone filled implants is a personal choice that depends on many factors. Your plastic surgeon should be able to help you make an informed decision.

Dr.T

Dear Dr. Togba

Q.  Breast Augmentation seems to be a popular procedure. I’ve done my research and found that there are several ways to do the surgery. What technique do you use? How do I determine which method is best?

 A. According to the American Society of Plastic Surgeons, over 340,000 Breast Augmentations were performed in 2007. As your research suggested, Breast Augmentation can be done through a variety of approaches such as around the areola, through the crease under the breast, the umbilical depression, or the underarm (axilla). The plastic surgeon you choose will usually have a preference to the technique that is used. Although I am comfortable using any of these approaches, I prefer the underarm incision. Through a very small incision in the axilla, I use an endoscope or camera, which allows me to establish a pocket under the breast for placement of the implant. For more natural results, I place the implant under the chest muscle. The advantages to the axillary approach are:

 • Patients maintain full breast sensation

 •There are no scars on the breasts nor incisions into the breasts

• There is no interference with milk production

•The incision in the underarm hid and fade for many to the point of invisibility

I’ve used the endoscope in my practice since 1992. I perform several Endoscopic Breast Augmentations weekly and have successfully performed two thousand since the beginning of my practice. My recommendation when looking for this particular approach is to make sure your plastic surgeon has experience with the endoscope. This my preferred method for Natural Looking Breasts.

Dr. T

Dear Dr. Togba,

Q.  One of my girlfriends just had her breasts enlarged. The surgeon put the implant through the armpit underneath the muscle and she said it was all done on a TV screen. Is this possible?

A. Yes. A popular technique in cosmetic breast augmentation are implants inserted through a one inch incision in the armpit, then positioned partially under the muscle. This surgical approach has the advantage of giving a more natural shape to the breast, which is an improvement over the appearance when the implant is placed totally under the muscle. This procedure has become possible because we are now using an endoscope which is a wand with a bright light and camera attached to it so that the surgeon is able to view what he is doing on a TV monitor just like when an orthopedic surgeon does knee surgery. To perform the surgery, a separate surgical instrument called an electrocautery must be inserted through the same entry point. The tiny "eye "of the endoscope’s camera allows a surgeon to view the surgical site more clearly than if the skin were opened from a long incision. There are other advantages with this procedure: risk of sensory loss from nerve damage is decreased and the recovery time is frequently shortened.

Dr. T

Dear Dr. Togba,

Q.  Can you tell me if women who have their breasts enlarged are usually happy with the results? Also, what are the main reasons they want it done?

A. Breast enlargement surgery, called augmentation mammaplasty, is the second most frequently performed plastic surgery procedure on women. A study of 592 breast implant patients, conducted in the early 1990s, found that 95 percent were satisfied with the results; the same percentage said they would definitely or probably choose surgery again. Different reasons motivate women to have this surgery. Some women with they had larger breasts. Other having size breasts just seek an increase of one cup size to improve their self image. And some find their breast size decreased after pregnancy and want their former shape and volume restored. Both saline and silicone implants are commonly used. There are three main ways to insert the implants. The surgeon can make the incision either in the armpit, under the breast where it meets the chest, or at some point around the edge of the areola. I prefer the armpit incision as it reduces the risk of losing nipple sensation and hides the scar away from the breast. Implants are centered beneath the nipples, either directly behind the soft breast tissue or underneath the chest muscle. Surgery takes one to two hours and most patients can return to work after five days.

Dr.T

Dear Dr. Togba,

Q.  I have a thin, attractive nose when viewed from the front but when viewed from the side, the tip curves down and there’s a hump on top. Can plastic surgery fix this?

A. Yes. Reshaping the nose is a basic cosmetic procedure and is the seventh most frequently performed plastic surgery procedure in California.

Dr. T

Dear Dr. Togba,

Q.  When you do a breast enlargement, what are the most popular sizes in your experience?

A. A patient seeking breast enlargement has the option of choosing the breast size she wants. This, of course, would depend on her height, chest dimensions, and whatever would be most pleasing to her. The most requested sizes in my practice are C and D cup.

Dr. T

Dear Dr. Togba,

Q.  I get the impression that cosmetic plastic surgery is something just for the ladies. Is that correct?

A. Not at all. Men have been availing themselves of cosmetic procedures in increasing numbers. They now account for 9% of all cosmetic surgery procedures in the United States. The most popular procedure for men is nose reshaping, followed closely by eyelid surgery and liposuction. Male breast reduction, facelifts, hair restoration, ear surgery, Botox, dermabrasion, and laser hair removal are other popular cosmetic procedures which are increasingly brining men into plastic surgeons’ offices throughout the country.

Dr. T

Dear Dr. Togba,

Q.  I’m an African-American male in my 30s. I don’t like my nose because it is flat and wide with flaring nostriles. I want a nose that better suits my face: strong and not so wide. How would you accomplish this?

A. I have performed rhinoplasties on cases very similar to yours. Your description and desires would lead me to believe that you want the bridge of your nose made higher, the base narrower, and the tip project more. To achieve a taller bridge, incisions are made inside the outer rim of the nostrils. Portions of cartilage are repositioned to bild up the bridge and project the tip. If necessary, pieces of bone or cartilage from other areas such ash the skull, rib, or ear can be used. To narrow the base, wedges of skin are removed from the base of each nostril. The outer rims are attached closer to the center leaving minute scars where the edges were stitched together.

Dr. T