Is 6 weeks a normal time frame to start massaging after breast augmentation?

Question

Hi I got 415cc high profile silicone implants. I went to my one week check up and my PS said that at my next appointment we will learn massaging techniques. He said at 6 weeks post op. I have noticed a lot of people start at 2 weeks. Is this normal to wait 6 weeks?

Gary Lawton, MD, FACS · Answer

Implant massage is a critical part of the postoperative recovery from breast augmentation (like physical therapy is a critical part of the postoperative recovery from knee surgery).  The space for the implant is meticulously crafted at the time of augmentation surgery, especially when the operation is performed using the surgical endoscope through the transaxillary approach.  However, the distance from the nipple to the inframammary fold needs to stretch out to accommodate the implant (dropping) and the skin and muscle need to relax to give the desired shape (fluffing).  Implant massage allows you to manipulate the pocket from the inside to direct the forces in the appropriate directions to mold the breast shape to the desired outcome.  If the scar that is actively forming around the implant is allowed to heal without the influence of breast massage, the fold will not stretch appropriately (implant stays too high), the scar will attempt to contract in a linear way over the curved surface of the implant (breast shape will remain too flat), and the space will attempt to heal smaller and tighter than the implant (capsular contracture).  Implant massage influences the scar formation on the inside at the most critical phase of the healing, allowing the space to be larger than the implant (mobility which creates the natural feel and bounce).  
  
Implant massage starts at one week at 5 times per day for one minute at a time and continues at this pace until one month.  I often see the patients weekly during this time to reinforce the technique and help the patients who need extra effort to soften the breasts. During this time period, the massage also breaks up the spasm, relieving the discomfort, particularly upon awakening from sleep (morning breast).  During the day, every time there is the sensation of tightness, implant massage breaks up the spasm and relieves the discomfort, minimizing the need for narcotics.  At one month, the force that can be exerted is increased but the frequency of massage decreases to 3 times per day.  As the wound matures, the massage can decrease to once per day forever as maintenance.  The patients integrate this into their shower routine.  
  
Although some patients can get away with no massage, it is a common issue for those who stop the massage and make none of their follow up appointment to suddenly show up years after surgery claiming that they woke up one morning with a capsular contracture and implant malposition.  Of course this did not happen overnight, but was a slow process that could have been prevented with daily maintenance massage and regular routine follow appointments on a yearly basis (which we provide for free, forever). With this type of perpetual follow up, it is possible to identify a problem early that might need a modification in the massage technique.  
  
Implant massage involves moving the device up against the wall of the pocket, holding pressure against the surface of the scar. The specifics are determined on an individual basis guided by what the patient needs. In some patients it is simple and of little significance.  In some patients it is a struggle to get the implants into the right position and to gain softness and mobility, but with the right technique and the appropriate dedication it is a huge success.  For the patients that do not participate in the massage in a meaningful way, some will get away with their lack of dedication because they were going to have soft breasts no matter what.  On the other hand, some patients will squander their opportunity to have an excellent result because they don't believe that the massage is necessary, or because they have been told by their friends or other doctors that they didn't need to perform massage.  Regardless, they often require surgery that could have been avoided by following the postoperative instructions of a surgeon that has performed nearly 10,000 breast implant operations and has seen the healing of each of those patients and integrated the successes and failures of each one into a postoperative plan that really works.
  
I find no use for bands, straps, bras or appliances after breast augmentation surgery.

Luke J. Curtsinger, MD · Answer

Massage recommendations vary between surgeons, and vary depend on the type of implants used.  I do start massage of round, smooth implants at 2 weeks, but later massage and no massage can also be effective.  I am not sure if any scientific studies have ever clarified the science behind these recommendations.  Ask your PS for their rationale.

Christopher J. Davidson, MD, FACS · Answer

Thank you for your question.  Implant massage instructions do vary from one plastic surgeon to another.  My protocol is that I do not recommended implant massage unless considered necessary during a post operative examination.  Best of luck.

Paul M. Parker, MD, FACS · Answer

The issue of massage and when to start it will vary from surgeon to surgeon. Best advice is to discuss it with your surgeon so that they can explain to you their rationale for having you do what they want you to do it and when.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  This is a widely debated topic on forums amongst plastic surgeons and as each of us has our own respective recovery protocol I would follow the instructions given to you as your surgeon feels they are appropriate.  No studies have ever been done that demonstrate either harm or efficacy of implant displacement exercises.  Hope this helps.

Daniel Barrett, MD · Answer

Dear stephgypsum,every plastic surgeon has his own postoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Steven Wallach, MD · Answer

Every surgeon is different. Some surgeons do not even recommend massage.  Best to follow with your doctor's instructions.

Jon Kurkjian, MD · Answer

Thank you for your question.
Every plastic surgery office has their own set of pre and post operative instructions that they recommend their patients follow. I encourage you to refer back to these instructions. If there are no specifics related to massage,  following up with your surgeon's office via phone or during a routine visit, can help you get all your questions answered.

Paul Wigoda, MD · Answer

I usually have my patients start at 3 weeks but each surgeon has their own technique and protocol so there isn't necessarily a right and wrong answer. I actually don't believe massaging is that important anyway. What matters most is the surgical technique. I ask my patients to push their implants inward and upward whenever they think about it but there is no minimum amount they have to do.

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