Tissue Expanders Before Breast Augmentation

I am in the "asking questions" stage before seeing a plastic surgeon as I am considering breast implants to enlarge a "barely A" to a "C" cup.  I am wondering if cost of implants has anything to do with outcome.  One nurse told me about tissue expanders before the actual implant will give a better look, any truth to this?  Also, since the shell of the implant is silicone any reason to not choose silicone fill?  Silicone fill sounds better as it is more natural feel and lighter, but would like to hear about what it is like to remove leaked silicone from tissue.  I understand implants last approximately  10 years and that puts me at 62 for a "redue".  Are there problems in healing, more or less with a redue.  

[Howard Rosenberg, MD]

While skin expanders are used in breast reconstruction to stretch a flattened chest wall after mastectomy, they are almost never used for routine augmentation.  Silicone gel implants avoid the rippling commonly seen with saline implants, and do feel more natural.  I have extensive experience removing the older leaking gel implants, which are more difficult to remove than the current, more cohesive implants.  I never "redo" an augmentation on a routine basis.  If there are no problems with the implants, there is no reason to re-operate.  

[arushi1]

I appreciate your response, but can you clarify your response regarding the 10-year shelf life of implants?  You say, "...there is no reason to re-operate." are you saying the newer silicone implants today do not (given there are no problems) need to be replaced?  Thank you.

[Howard Rosenberg, MD]

The manufacturers of these implants have a consent form that asserts that the gel implants are not lifetime devices, and sometime in your life, they will require removal with or without replacement.  There is no specific time table when one can absolutely predict when this will occur.  For anyone undergoing this surgery, it is a myth to assume that surgery will be required every ten years.  If there are no physical problems or radiologic (or MRI) evidence of rupture, there is no need to routinely remove and replace at regular intervals.  In my personal experience to date, I have never had to remove or replace the current generation of implants for implant failure.

[arushi1]

Thank you for responding to my inquiry, your answer has helped me in making my decision.