One week pre-op now....Dr. doesn't want me to start my daily massages for breast lift/aug at least until my next appt in 6 weeks. I am worried about Capsular Contracture. My healing looks good and no problems... Why wait on daily breast manipulations? Is this normal? I went from a saggy small B to 375ccs larger.
Doc Says Don't Do Daily Massages for Breast Lift/Aug? Worried About Capsular Contracture.
Doctor Answers 15
Massage after Breast Augmentation
Many of us recommend post-op massage but would all agree that it has never been proven to reduce the chance of capsular contracture. It may help the implant settle into its' final position by stretching the muscle and breast tissue of the lower portion of the breast. You have chosen your surgeon and are doing well, so trust your choice and try to not second guess him or her.
Better to listen to your surgeon
Breast lift and augmentation and massage
Massage is not recommended by all surgeons, and there is no scientific proof that it helps at all. Even those that recommend it, may not want you to do it with a lift procedure.
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Preventing Capsular Contracture in Breast Augmentation
Capsular contracture, or hardening of the scar around a breast implant, is a complication of breast augmentation surgery that can be difficult to treat. The specific cause has not yet been scientifically proven but there are leading theories as to what the cause might be. Along these same line, the best method of preventing contracture has not been proven either. There are certain measures that can be taking during surgery and perhaps in the post operative period to help lesson the chance of contracture. I would recommend that you follow your surgeon's guidelines and discuss the rationale for the timing of massage with your surgeon.
Breast Augmentation Massage
It is important to remember that a slow steady stretch is more effective than a quick jerky movement. Don't worry about injuring the implant, you cannot cause a rupture with these breast exercises.
- Press the breasts slowly and maximally inwards (towards your breast bone) and hold for 10 seconds, then release. Repeat 4 times.
- Press the breasts apart slowly and maximally outwards and hold for 10 seconds, then release. Repeat 4 times.
- Repeat for downward movement.
- Repeat for upward movement.
When to start different types of Breast Massage.
Thank you for your post. 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.
In an aug/lift, if the implants are in great position, then no need to do early massage, and if you do, do #4 gently. Otherwise if you are trying to accomplish 1-3, then this is the regimen 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
Breast Massage after Mastopexy and Augmentation
Many physicians wait until the incisions are healed from the mastopexy (breast lift) before they start the massasing of the implant so that the incisions won't open.
Massage and Capsular Contracture
There is no evidence that massage will decrease the risk of capsular contracture. It sounds like you should listen to your surgeon's recommendations.
Massaging Implants after Augmentation + Lift
In my practice, I generally encourage manipulation of implants to prevent capsule contracture.
As you can see from the comments here, experts may disagree on techniques, but surgeons will generally agree on advising your following the recommendations of your surgeon. It is reasonable to ask your surgeon if there is a particular reason he/she is having you postpone manipulation. For example, one reason could be minimizing stres on new suture lines.
Implant massage does not prevent capsular contracture
There is no evidence from clinical studies and no theoretical basis for implant massage to prevent capsular contracture. It is sometimes helpful to encourage implants to settle into the right position. Go with your own surgeon's advice.