Could a deep tissue massage have triggered a lingering pectoral spasm or early capsular issue?

Question

I’m 7 months post-op from submuscular breast implants and had been healing without issues. About 2 weeks ago, I developed mild right shoulder soreness and got a deep tissue massage focused on my upper back. Two days later, I had sudden right breast pain, swelling, and firmness — the breast felt harder, higher, larger, and more uncomfortable. My surgeon diagnosed a pectoral spasm likely caused by overexertion from physical activity (intense workouts) and prescribed a Medrol dose pack, rest, and muscle relaxants. I initially improved a bit while on the Medrol, but symptoms have since returned and plateaued despite avoiding activity. Could this still be muscular, or should I be concerned about early capsular contracture or another implant-related complication?

Leila Kasrai, MD, FRCSC · Answer

Please see your surgeon for an assessment. You will need to be examined to determine whether capsular contracture has developed.

Camille Cash, MD · Answer

I encourage you to return to your surgeon for a follow up since your condition hasn't improved.  Your surgeon can help determine if capsular contracture is present from an exam.  If it is the treatment will depend on the degree of the contracture.  I've included a video I hope you find helpful.

James Knoetgen, III, MD · Answer

Given your history and symptoms, both muscular and implant-related causes are possible, but based on the timeline and progression, here’s a breakdown of what might be happening:
Muscular (Pectoral) Spasm or Strain – Still the Most Likely Cause
•	Deep tissue massage can irritate or overstimulate the pectoral muscle, especially post-submuscular implant placement. Even though the massage was focused on your back, tension release or pressure around the shoulder blades, traps, or rhomboids can indirectly affect the anterior chest wall and pectoral insertion points.
•	Combined with intense workouts, your muscle could have entered a prolonged spasm or developed localized inflammation.
•	The sudden onset of symptoms (pain, swelling, firmness, and high-riding breast) strongly suggests muscle involvement rather than the gradual process of capsular contracture.
•	Medrol dose pack improvement followed by plateauing once the steroid wore off also supports a muscular or inflammatory etiology rather than true fibrotic capsule development.
Early Capsular Contracture – Possible but Less Likely (For Now)
•	Capsular contracture typically:
o	Develops more gradually (unless due to hematoma or infection)
o	Is not usually triggered by massage or activity alone
o	Doesn’t resolve at all with steroids or muscle relaxants
•	However, grade 1-2 early contracture can start subtly and mimic muscle tightness, especially if inflammation is involved.
•	If your breast is:
o	Progressively firmer
o	Not relaxing with muscle relaxants
o	Changing shape or symmetry significantly
Then capsular contracture could be evolving, and a follow-up exam or imaging may help clarify
Imaging Consideration
If symptoms persist past 2–3 weeks or worsen, you might benefit from:
•	Ultrasound – to check for seroma, hematoma, or thickened capsule.
•	MRI with contrast – for a more detailed implant and tissue assessment, especially if capsular contracture is suspected.
Differential Possibilities to Consider
•	Localized seroma or fluid collection: May mimic swelling and firmness
•	Muscle adhesion or nerve entrapment: Especially if discomfort radiates
•	Minor implant displacement or rotation: Rare with round implants, but can mimic asymmetry or tightness
What You Can Do Now
1.	Continue avoiding upper body workouts or stretching until symptoms stabilize.
2.	Use muscle relaxants and NSAIDs under guidance, even post-Medrol.
3.	Apply warm compresses and consider gentle chest wall massage (once cleared).
4.	Schedule a re-evaluation with your surgeon if symptoms do not significantly improve in another 1–2 weeks.
5.	If there's concern about implant position, consider baseline imaging now rather than waiting.
When to Escalate:
•	Rapid re-hardening or size change
•	Visible asymmetry or distortion
•	Fever, redness, or signs of systemic inflammation
•	No improvement within a reasonable window (2–4 weeks)
Yes, a deep tissue massage, especially in combination with workouts, could reasonably trigger a pectoral muscle spasm or strain, even several months post-op. This remains the most likely cause. Capsular contracture is a possibility, but your timeline and partial response to steroids lean more toward muscular inflammation. Ongoing monitoring and possibly imaging are warranted if there's no further improvement.

Connie Hiers, MD, FACS · Answer

You will need to go back to your surgeon and be examined. Your surgeon can tell by exam if a capsule is present.

Could a deep tissue massage have triggered a lingering pectoral spasm or early capsular issue?

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Could a deep tissue massage have triggered a lingering pectoral spasm or early capsular issue?

Answers (4)

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