What surgeons keep quiet about: hidden nuances of breast augmentation and lifting from Dr. Guler Gamze

Dr. Güler Gamze Eren is a specialist in plastic and reconstructive surgery. She was born in 1985 in Giresun. In 2009, she graduated from Uludag University, Faculty of Medicine and received the title of Doctor of Medicine. She received her special education at Kocaeli University, Department of Plastic, Reconstructive and Aesthetic Surgery between 2009 and 2015.

• 2013 Participated in cleft lip and burn surgeries in Bukhara and Uzbekistan with the support of TIKA
• 2015-2016 Kocaeli Gebze Fatih State Hospital
• Observer at the University of Rochester Children’s Plastic Surgery Clinic with the support of Rotary in June 2015
• 2016-2017 Kocaeli Derince Training and Research Hospital
• 2017- 2019 Istanbul Sultan Abdulhamit Han Training and Research Hospital
• 2019 -2021 Esteworld Altunizade Plastic Surgery Complex
• 2021 December – Currently in private practice in Istanbul

What breast lift methods do you use and how do I choose the right one for my patient?

Dr. Güler Gamze: I use several breast lift methods, including anchor incision, vertical incision, and periareolar method. The choice of the appropriate method depends on the degree of breast sagging and the individual characteristics of the patient. During the consultation, we discuss all the options in detail to choose the most effective method that will give the best result.

How is breast augmentation with implants performed?

Dr. Güler Gamze: Breast augmentation with implants takes about 1-2 hours and is performed under general anesthesia. We use high-quality implants that can be placed under the pectoral muscle or under the gland. The choice of placement site and type of implants is discussed during the consultation to achieve the most natural result.

Is it possible to have a breast lift or breast augmentation without using implants?

Dr. Güler Gamze: Yes, we can enlarge the breasts using lipofilling, which uses the patient’s own fat tissue. This method is suitable for those who want a natural enlargement without the use of synthetic materials. However, it is limited in volume, so it is suitable for moderate breast augmentation.

Can a breast lift without implants give the same effect as with them, or is this just a marketing ploy?

Dr. Güler Gamze: A breast lift and breast augmentation are different surgeries and they solve different problems. A lift improves the shape and eliminates sagging, but does not add volume. Implants are needed if the patient wants to increase the size and add volume. This is not a marketing ploy, but a medical necessity depending on the patient’s expectations. Both approaches have their indications and are selected individually.

Is it true that surgeons select the right size of implants right during the operation?

Dr. Güler Gamze: Yes, in some cases, surgeons can actually select the final size of the implant during the operation. This is done in order to select the implant as accurately as possible, corresponding to the patient’s anatomical features and aesthetic preferences.
Before the surgery, I conduct a thorough consultation, during which the desired results are discussed and several possible implant sizes are pre-selected. Before the surgery, I order at least three implant options so that I can choose the most suitable size during the surgery. After inserting a temporary trial implant, I evaluate how well the implant “fits”, what the shape looks like, and how the tissues react. At this stage, a decision may be made to insert a larger or smaller implant, depending on how the skin and muscles react to the tension and shape of the implant.

Do the implants need to be replaced in the future?

Dr. Güler Gamze: Yes, although the implant manufacturers state that their products do not require replacement in the future, as a plastic surgeon I actually recommend replacing them after 10-15 years. The main reason is that even if the implants themselves remain in good condition, the body’s tissues change with age. The quality of the skin deteriorates, and the implant may stretch, sag, or shift due to natural changes in the body.
Over time, the skin may lose elasticity, causing the implant to change position, or other changes may occur, such as capsular contracture (formation of scar tissue around the implant), which may also require correction. Therefore, doctors recommend monitoring the condition of the implants and surrounding tissues with regular check-ups and, if necessary, planning their replacement in order to maintain the aesthetic result and avoid possible complications.

Is it true that after breast augmentation with implants, the patient will still have to come back for a breast lift after some time?

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Dr. Güler Gamze: Not always a lift is required after breast augmentation with implants. If the patient is young, has not given birth, and has good skin quality, a lift is usually not necessary. In such cases, the skin is usually elastic enough to support the new breast volume without the need for correction. However, if the patient has given birth and breastfed, the breast tissue may become less elastic and the skin may stretch. In such cases, even with breast augmentation with implants, a lift (mastopexy) may be necessary to achieve an aesthetic result. In the future, especially after significant body changes such as pregnancy or significant weight loss, a second breast lift may be necessary – this is called revision surgery.
It is also important to consider the size of the implant. The larger the implant, the higher the likelihood that the skin will stretch and the breast will sag over time. Therefore, the choice of implant size should be carefully coordinated with the anatomical features and tissue condition of the patient in order to minimize the risk of future complications and the need for repeat surgeries.

Is it true that with breast lipofilling, fat takes root better if stem cells are added?

Dr. Güler Gamze: Yes, with lipofilling, it is true that about 30-40% of the transplanted fat tissue can be reabsorbed over time. This is normal and is due to the fact that not all fat cells receive the necessary blood supply to take root in the new area. Stem cells have the ability to stimulate tissue regeneration, improving the blood supply and the take root of the transplanted fat. By adding stem cells, the percentage of fat resorption can actually be reduced to 15-20%, which is a significant improvement over conventional lipofilling.
However, it is worth noting that this method is not a standard and requires more in-depth research to confirm its effectiveness in each specific case. Results may vary depending on the surgical technique and the individual characteristics of the patient.

How to choose between implants and lipofilling for breast augmentation, and is it possible to combine them with a lift?

Dr. Güler Gamze: If the patient wants a more significant increase and a predictable result, then implants are the best choice. Lipofilling is suitable for those looking for a natural, but less voluminous increase. It is also possible to combine a breast lift with augmentation using implants, which is especially popular among women who want to restore the shape of their breasts after pregnancy or weight loss. Such a combined operation allows not only to lift the breasts, but also to add the desired volume, providing a natural and harmonious result.

How to properly prepare for breast lift or breast augmentation surgery?

Dr. Güler Gamze: Preparation for surgery includes taking tests and stopping smoking and drinking alcohol 2 weeks before the procedure. It is important to tell me about all medications and supplements you are taking. If you are taking medications that affect blood clotting (such as aspirin or ibuprofen), you should stop them 1-2 weeks before surgery to reduce the risk of bleeding. Preparation plays an important role in the successful outcome of the surgery.

It is important to understand that full recovery may take several months, including tissue healing, resorption of swelling, and restoration of the natural appearance of the breast.

Before and After Photos:

Below are examples of Dr. Güler Gamze’s work. These images demonstrate the results of breast lifts and breast augmentation using various methods. The photos will help you better understand the possible results and choose the right method for you.