To minimse the risk of capcular contracture after a small haematoma dispersed by itself (undrained)the advise has been to massage the breast regularly -does this stand when we're talking about a textured silicone gel implant.I had heard that textured implants shouldn't be massaged.If there's dried blood in the breast cavity(hypothetical),would massage really help minimise contracture risk?Finally,if contracture were to occur & the implant replaced,is it possible for no cc to occur the 2nd time?
Capsular Contracture - Should I Massage Silicone Implants?
Doctor Answers 5
Re: Should I Massage Silicone Breast Implants?
Unfortunately studies have shown that a hematoma, even one that is small does increase the incidence of capsular contracture. That is why surgical drainage is generally performed if the hematoma is at all significant. Fortunately, capsular contracture with the new cohesive gel implants, whether textured or smooth, is very low which is to your benefit. Even though the implants are textured, gentle massage may be helpful, and certainly there is no down side to it. Once you reach six months, the incidence of capsular contracture drops off significantly and the need for massage would be less of an issue. If you do not see any distortion to the breast at this point in time, then in all probability you should do well. As for open capsulotomies to treat capsular contracture, they are successful in the majority of cases but capsular contracture can recur.
Massaging breast implants
The general consensus among experienced breast surgeons is that smooth implants need to be massaged whereas massaging a textured implant defeats the purpose of the texturing. This may not apply to Mentor textured implants because their texturing is lees aggressive than Allergan's. The recurrence rate for capsular contracture has been reported to be as high as 50% but my experience with it has been far more favorable.
Breast Massage Technique
Thank you for your post. It depends on what the purpose of the massage is. If to help prevention of capsular contraction, then this should be done for the life of the implants. Unfortunately, capsular contraction can happen at any time, even 10 years down the road, whether or not you have smooth or textured implants, however, you should follow some sort of massage technique. Certainly with textured implants if the massage technique is done too aggressively or incorrectly, then you can detach the tissue ingrowth to the textured surface. Massage is not a full proof prevention of capsular contracture, but it helps. After a hematoma, the likelyhood of a CC is higher, but massage may be helpful.
There are many reasons why one would want to do breast massage after surgery. These include,
1. to try to massage an implant into place that is assymetric with the other side,
2. to try to massage implants down that are too high,
3. to try to massage a constricted area of the breast to loosen up, as in tubular breasts, and finally
4. to try to prevent capsular contraction around the breasts.
As you probably have guessed, the type of massage for these different issues will be different as we are trying to accomplish different things. If the massage is done incorrectly, or past the point of symmetry when trying to lower an implant, then yes, it can cause bottoming out or widening. Follow these guidelines to avoid this. Your implants will get softer natually as the swelling goes down, so you should always follow your particular doctors recommendations regarding massage. These are the instructions I give my patients:
1. When the implants are assymetric, or appear to be at different levels or height, then the massage is different from side to side. This occurs sometimes if the implants are placed under the muscle and one muscle is released slightly different from the other side, or the muscle is naturally larger or different shape from the other side. Sometimes massage is performed to one breast only, and sometimes to both breasts but in different directions. You should ask your surgeon for specific instructions as every situation is different, but in general, think of the breast as a 'circle', and massage with significant breast on the opposite side of the circle that you want the implants to go. You have to feel an actual stretch in the tissues in the area that the implant need to go for this to be of benefit, otherwise you are not really accomplishing anything. If the massage is in the direction of the incision, I usually protect the incision with steri-strips in order to keep the scar from widening in the early first 3 months during the massage. The massage needs to be finished in the first three months and started early, otherwise it will have little to no benefit. Look at the breasts and analyze the symmetry and where the deficient areas are to make a nice smooth beautiful contour, and stop once that goal is achieved.
2. When the implants are high, and have not dropped, but are symmetric, some physicians use a tension band on top of the breasts, some ask the patient to go without a bra and allow gravity to slowly move the implants, some do a similar massage to the above but doing exactly the same thing on both sides. Consult with your physician on this.
3. When there is a constricted breast like tubular breasts, I sometimes have the patient massage as in #1, sometimes have them massage both sides of the 'circle' to loosen the constricted skin, and usually leave the patient out of a bra if both sides have tubular breasts or constriction at the bottom, or if only one side is constricted, have the patient wear a bra, but cutting out he cup on the side that is constricted, so that only the normal side is supported.
4. Finally, maintenance massage. I disagree with surgeons who want to keep the pocket or 'capsule' of the breast where the implant is contained larger than the implant. This aids in the implant becoming more and more displaced over time, with more separation at the cleavage point especially when you lay down, and can also cause sagging of the breasts. I actually use textured implants as a way to fight the implants moving inside the capsule of the breast so that they stay 'perky'. Natural 'perky' breasts stay in place when standing up or laying down, so 'perky' implants should do the same. I think the implant should fit in the capsule or breast pocket like a glove, and actually be adhesive to it. Thus there is a 'perfect' amount of massage that is necessary to keep this capsule flexible, but not wider than the actual implant and thus allow for movement of the implant and thus sag. I like grabbing the breast and pressing the opposite sides of the 'circle' toward the center, causing the central or nipple area to bulge out. I have my patients do this pushing the top and bottom together, the sides together, and then both diagonals together. This puts more pressure on the central portion of the implant, rather than the sides to allow the implant to continue to be adhesive, but the capsule to not widen. I ask my patients to develop a routine and do it in their morning shower, this way it becomes habitual and they won't forget, as this is a lifelong routine that should be performed.
Pablo Prichard, MD
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I usually have my patients massage but I usually use smooth walled implants. Ask your doctor how you should proceed.
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See video for suggested exercises if permitted by your surgeon. Blood within the pocket does not universally mean implant contracture.
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.