Am I Doing the Correct Breast Augmentation Post-op Massage So As Not to Widen Pocket?

I have sub- pectoral saline implants 360-380cc. I am seven weeks post-op. I have only been doing massage of implants inward to encourage implants to come together more and sometimes downwards to encourage implants to settle. Will these types of massage put me at risk for widening the pocket? I am nervous to do the wrong thing and have the pocket widen resulting in implants spaced too far apart.

Doctor Answers (8)

Displacement Exercises for Smooth Breast Implants Does Not Affect Pocket Size

+2

The displacement of breast implants is recommended to reduce the risk of capsular contracture. Perhaps that is unproven, but I have seen a few isolated cases where aggressive massage has helped to loosen a tight pocket that has begun to form when displacement was not being performed adequately.

Displacement of breast implants is done for smooth surfaced saline- and silicone gel-filled implants; it is not recommended for breast implants with a textured surface. Smooth breast implants will move freely within the pocket, while textured surface implants do not move -- either because of increased friction caused by the texturing, or capsular adherence to the textured surface.

Medial displacement of your implants is a normal part of the displacement exercise routine – but it will not allow them to move medially, since the medial border of the sub-pectoral pocket is defined (and limited) by the medial insertions of the pectoralis major muscle to the sternum. Nor, will the displacement exercises you have described cause widening of the pocket.

I have my patients begin implant displacement exercises one week following surgery. The acute pain of surgery has subsided by then so the displacement can be done a bit more comfortably.

Displacement Technique:

>> Place your hand flat over the central breast and press the implant inward towards the chest wall. Hold it there for a few seconds.

>> Lift each implant up; with your hand under the implant, slide it up the chest wall slowly, pushing it up towards the clavicle. Hold it there for a few seconds.

>> Push the implant medially; with your hand on the lateral part of the implant, slide it towards the sternum. Hold it there for a few seconds.

>> Push the implant laterally; with your hand over the medial breast, push the implant laterally. Hold it there for a few seconds.

The right implant can be displaced with the left hand, and vice versa. The displacement should be performed slowly and steadily with moderate force. Each displacement should be performed ten times.

Initially the displacement of the implant will be somewhat limited. But as swelling subsides, the tissues stretch, and the implant settles, the implants will move more easily in the pocket. Pain may somewhat limit your ability to move the implants initially, but as this subsides you will be able to displace the implants much more readily.

I only have patients push implants down if I feel they are not settling as intended.

Since there is a thought that these displacement exercises may reduce the risk of capsular contracture, I recommend the following frequency -- Perform these exercises three times daily for six months following surgery, then two times daily for the next six months, and then once daily thereafter. Prolonged use of displacement exercises may be more important for subglandular implants, as subpectoral implants seem to have a lower risk of capsular contracture.

Best wishes.
Kenneth Dembny

 


Milwaukee Plastic Surgeon
5.0 out of 5 stars 17 reviews

Breast Massage and Implant Displacement

+1

I do not think massaging can widen an existing breast pocket.  The tissue does not stretch this easily in my opinion.   I am a big advocate of breast massage.  I like to wait until the first postoperative visit to begin massage for three reasons.  

1.  I do not want excess tension on the fresh incision, which can cause wound healing problems
2.  Massage will increase soreness and I want to get patients off pain medication as quickly and safely as possible.
3.  Early massage can increase the risk of bleeding, which is the number 1 cause of capsular contracture/scar formation.

For this reason, I begin massage therapy at the first visit, which is 4-7 days postop.  I then establish a regimine of 3 minutes of massage 3 times a day for 3 months.
I do prefer a bra, especially in physically active patients, as I find it helps prevent the implant from dropping too much and causing implant malposition.

Paul S. Gill, MD
Houston Plastic Surgeon
5.0 out of 5 stars 34 reviews

Post implant massage

+1

It is extremely rare to change a pocket after breast implant surgery.  The main goal is to prevent a visible or painful capsule.  If there were technical problems with creating the pocket, overaggressive dissection or muscle release, release of the fold beneath the breasts, a collection of blood or even a mild infection of the implant (which is referred to a biofilm), then an abnormal capsule can result.  At seven weeks, you will not harm the pocket.  

Tito Vasquez, MD, FACS
Southport Plastic Surgeon
5.0 out of 5 stars 3 reviews

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Displacement exercises fro breast augmentation

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Some doctors recommend displacement exercises and others do not., and still those that recommend them may alter the exercises based upon what type of surgery the patient had performed. Your best bet is to ask your surgeon.

Steven Wallach, MD
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Breast Implant Massage

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Hello Jennylea,

Implant massage has no proven benefits, and I don't ever recommend it to my patients.  It will not prevent capsular contracture and it will not cure a tight or contracted capsule that has already formed.  Massage will not stop or prevent implant malposition toward the sides/armpits.  Saline implants have a propensity to drop with time, more than silicone gel implants, so there is no need to encourage them to drop either.  By this time, your breasts should be taking on a nice shape.  If this is the case, than don't be concerned about what might happen later. If you feel your implants are too far apart or too high, than discuss this with your plastic surgeon.

Best of luck!

Gerald Minniti, MD, FACS
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Massage keeps implants soft after surgery

+1

I recommend that my breast augmentation patients massage their implants after surgery. I typically recommend they start 2-3 weeks after surgery with this. I recommend they feel the implant at the outer, inferior aspect and squeeze the implant superiorly and centrally. I don't like for my patients to massage the implant outward or downward. The most important thing is breaking up any healing scar around the implant to keep the breasts soft and not allow significant scar tissue to organize around the implant.

Michele A. Shermak, MD
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Breast implant massage advice

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There are two reasons why massage to the breasts after augmentation might be recommended. One,as it sounds like you are doing, is to help keep the implants in the right place during the initial healing. Once the scar capsule forms,which takes about 6 weeks, this should no longer be necessary or helpful. The other reason is to prevent capsular contracture, which is a completely unproven idea.

Richard Baxter, MD
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Breast Augmentation Plastic Surgery Specialists of New Jersey

+1

Dear Jennylea

The massage techniques after breast augmentation has to be done correctly both in specific technique and frequency. The main issue is to perform the massage correctly and frequent enough to obtain the desired result. The massage should start as soon as you are comfortable. Your plastic surgeon should review with you how it is done. Essentially you gently push the implant towards the direction where you want the pocket, hold it inplace for 10 seconds and repeat. Push the implant toward the middle and downward. This is the appropriate direction, and it should be done for 10-20 minutes at a time and three to four times per day. These are the essentials, and it must be done correctly or you will enlarge the pocket especially with saline implants. I find my patients should focus on two things after surgery. One is shaping which is accomplished by using the surgical bra and massage. The other is scar control which can minimize the line.  

Frank J. Ferraro, MD
Ridgewood Plastic Surgeon
4.0 out of 5 stars 2 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.