Dr. Stanley P. Gulin at Plastic Surgery Associates of Naples / Fort Myers has been performing breast enlargement (breast augmentation) for over 25 years. Many women feel that their breast size is out of proportion to their body frame and wish to enlarge their breasts to be in balance with the rest of their torso. Often a more shapely, fuller breast allows women to wear various styles of clothes more easily. Some women have one breast that is distinctly different in size from the other causing difficulty in wearing undergarments as well as embarrassment.
As a board certified plastic surgeon in Naples Dr. Gulin uses both Mentor and Allergan (Natrelle) cohesive gel implants as well as Mentor Spectrum post-operatively adjustable saline implants. As women age, and particularly following pregnancy, the breast goes on to sag with the nipple-areolar position being lower than desired. For a certain number of women Dr. Gulin is able to raise the position of the breast and nipple solely through breast enlargement (breast augmentation) with a breast implant. Many women find that breast enlargement (breast augmentation) not only increases the fullness and projection of their breasts but improves the balance in their figure resulting in an enhancement of their self-image and self-confidence. Through a choice of several types and styles of implants they are able to achieve fuller, natural appearing breasts.
Breast enlargement (breast augmentation) involves placement of a breast implant either under the breast itself or in a deeper layer underneath the muscle. Implants can either be FDA approved silicone cohesive gel filled implants or saline filled implants whose size can be adjusted for several months after surgery. Dr. Gulin has had extensive experience using both types of implants achieving excellent results with both.
Silicone vs. Saline Implants
Silicone implants became available in the 1960’s and were in continuous use until 1992 at which time the FDA halted their use in order to perform additional studies relating to their safety. After 14 years of study, the FDA concluded that there was no increased risk of certain conditions. At that time the two major manufacturers of silicone implants again placed them on the market, this time using an even more improved gel implant called a cohesive gel implant.
Cohesive gel silicone implants feel very natural with less tendency for rippling. Overall they give a very natural appearing breast shape and feel akin to the breast itself. Dr. Gulin uses both Mentor and Allergan (Natrelle) cohesive gel implants. Usually these are round implants with a smooth surface. Although rupture of the implant is possible, the rupture rate is small and both companies back up their implants with an excellent replacement program.
Dr. Stanley P. Gulin at Plastic Surgery Associates of Naples - Fort Myers is the only plastic surgeon in Collier County, and one of the few plastic surgeons in South Florida, to routinely use postoperatively adjustable saline implants. The Spectrum implant by Mentor Corporation has a small fill valve, which is buried underneath the skin next to the implant insertion incision. Through this filling valve the implant volume can be changed for up to four to six months with a resulting change in the breast size. At that time under local anesthesia the valve is removed through the same incision. Saline implants are slightly firmer in feel and may have some rippling if they are not adequately filled. If a woman has a reasonable amount of breast tissue over the implant usually rippling is not apparent and the breast feels almost as soft as with a silicone cohesive gel implant. The distinct advantage of the saline implant is that if rupture should occur only harmless saline leaks out of the implant. In addition, the postoperatively adjustable saline implant allows a woman to not only change the size of the implant following surgery but also balance one breast with the other to correct for subtle differences. Because the saline implant is placed into the breast in a collapsed shape a slightly smaller incision can be used than with the silicone cohesive gel implant.
Breast Augmentation Procedure
Prior to performing breast augmentation Dr. Gulin at Plastic Surgery Associates of Naples - Fort Myers works with the patient to determine the appropriate size and type of implant that will result in the breast size and shape that the patient desires. This is done preoperatively with trial implants, bra sizing at home and in the office, as well as photographs of various pre and postoperative breast sizes.
The incision through which the breast implant is placed can be at the border of the areola, underneath the breast in the inframammary fold, or in the armpit. Each incision has its own advantages and disadvantages. For each patient Dr. Gulin discusses the relative merits of each type of incision.
Dr. Gulin, as well as many plastic surgeons, feel that there is less chance of postoperative firmness around the implant if the implant is placed in a submuscular position underneath the chest muscle. In this position the implant is less visible or able to be felt. The breast is more easily examined in routine exam as well as by mammography. In addition, there is less chance of interference with nipple sensation or breast feeding when the implant is placed in the submuscular position.
Surgery is performed under twilight sleep sedation anesthesia in the fully accredited on-site surgery suite in Naples, Florida. During the surgery Dr. Gulin uses various trial implant sizers to determine the optimal implant size for each breast. In addition, an Accufuser® pain pump can be used to decrease postoperative discomfort. This device consists of a small pump worn by the patient through which numbing medicine is pumped into the implant pocket for several days postoperatively, allowing the patient to be much more comfortable and needing less pain medication.
If needed, Dr. Gulin also performs a breast lift (mastopexy) with the augmentation in order to lift the breast and position the nipple higher on the breast.
What Can I Expect During My Breast Augmentation Consultation?
Prior to your consultation with Dr. Gulin, you need to do some homework. It’s a good idea to research implant options, incision options, implant size considerations, and implant projection options. Look at before-and-after galleries from Dr. Gulin to see changes similar to what you may be looking for. You should become somewhat of an expert on augmentation, so that you can ask specific questions of Dr. Gulin.
The two of you will discuss your goals and expectations for your augmentation. Dr. Gulin believes it is very important that the patient is opting to have her breasts augmented for herself, not at the behest of a partner. He also wants to be sure your expectations are realistic.
You’ll discuss your medical conditions, drug allergies, and any previous surgeries. You’ll need to detail any medications you are taking, including vitamins and herbal supplements, and your alcohol, tobacco, and drug use. Family history of breast cancer will be discussed, as well as any previous biopsies you may have had.
Dr. Gulin will perform a general examination of your health status, checking for any risk factors with surgery. He will examine your breasts, measuring size and shape, along with skin quality. He will take photographs of your breasts for“before” photos.
From there, you’ll discuss your options. Do you understand the difference between silicone and saline implants? He’ll talk to you about the implant placement; he believes placement under the chest muscle is the best course, if possible. And you’ll discuss any possible complications with this procedure.
This is your time to interact freely and to ask all the questions you have.
How Do I Decide Between the Different Types of Breast Implants?
Saline and silicone implants each have their advantages. For instance, most people believe silicone implants have a more natural look and feel. Silicone implants also have less risk of rippling. Unlike silicone, if a saline implant ruptures, the body simply absorbs the saline solution.
Dr. Gulin is one of the few plastic surgeons in South Florida experienced with the new postoperatively adjustable saline implants. These implants have a small fill valve, which is buried under the skin next to the incision insertion location. Through this valve and a minimal repeat incision, the implant size can be adjusted for up to six months after initial placement. At that point, the valve is removed permanently. This affords the patient some peace of mind knowing that she can adjust the size of her augmentation is she chooses once the implants are in place.
Dr. Gulin will discuss with you all the pros and cons of your implant choices. This will help you make your decision.
Will My Enhanced Breasts Feel Natural?
Gone are the days of rock hard silicone implants. Today’s silicone is more cohesive, meaning it tends to stay together in a thicker gel-like consistency than older implants. The general consensus is that these new silicone implants feel very similar to natural breast tissue. Plus, Dr. Gulin believes there is less chance of postoperative firmness around the implant (a condition known as capsular contracture) when the implants are placed in a submuscular position underneath the chest muscle.
How Long Do Breast Augmentation Results Last?
Breast augmentation is not a once-in-a-lifetime event for most patients. Modern implants have improved a great deal from those available in the 80s and 90s, but they still have a lifespan. Implants can last up to 25 years, or they can last far less than that — there is neither rhyme nor reason to this. The general length manufacturers claim is an average of 10 years. Implants can rupture through trauma or just wear. Rippling can occur, although this is rare when the implants are placed beneath the chest muscle. And scar tissue can develop around the implant, called capsular contracture, hardening the area around the implant and sometimes causing a squeezing feeling in the chest.
Of course, despite having implants, your breast tissue will continue to age and sag. Implants keep the breasts in a higher position, but aging is inevitable. Often a replacement procedure may include a breast lift to compensate for sagging tissue.
After the Breast Augmentation Procedure
Most patients find that with the pain pump their discomfort is minimal. Moderate swelling persists for about one week. If the patient has chosen a saline postoperatively adjustable implant, adjustments to the final volume can be made starting in about one to two weeks following surgery. In addition, the patient is instructed in breast massage by Dr. Gulin and his staff in order to keep the breast soft and free of scar tissue (capsule) around the implant. Most women return to their usual work activities in about five days following surgery and back to full exercise in three weeks following surgery.
Following your breast augmentation the breast size is much more in proportion to your body frame, height, and weight. The breast feels natural and appears smooth in contour. In addition, because the implant is in a submuscular pocket the breast implant and its surrounding breast tissue move naturally with any body motion.