I Have Hardening of my Implant in One Breast. Will Massaging Make Any Difference?

i had my implants 4 years ago this summer. i have no problems at all with the other one.

Doctor Answers 10

Could be capsular contracture

Hardening of the breast can be an indication of capsular contracture and massage will not help. Please see your surgeon to discuss this concern.

Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

One Hard Breast 4 Years Post Op - Will Breast Massaging Be Of Any Value?

I am not a big fan of breast massaging to keep breasts soft, but even those that believe in breast massaging would admit if breast massaging has any value at all, it is before the breasts get hard. Capsular contracture or hardening breasts are separated into four categories from soft to distorted. This was originally described by Jim Baker, M.D. of Winter Park, Florida. If you are aware your breast is hardening, you are in Category 3 or 4. Baker Category 1 means your breast is soft and there is no problem. Baker 2 is early capsular contracture which the surgeon recognizes but the patient does not. Therefore since you recognize the hardening, it is in Category 3 or 4.

Capsular contracture is scar tissue immediately around an implant initially. Since this capsule is tightly applied to the wall of the implant, and since breast massaging at best stretches the limits of the implant pocket, all you would be doing by massaging a Baker 3 or 4 would be to move around a hard breast, potentially making a larger pocket, but you would still have the same hard breast.

Breast hardening is an immune phenomenon. Your body is attempting to protect you from this invader (the breast implant). All mechanical attempts to treat this tight capsule around your implant are doomed to failure. You need to treat the problem which is a biochemical/immunological phenomenon. Although controversial, the use of a leukotriene receptor antagonist by mouth plus external ultrasound (the kind physical therapists use for sore muscles) has shown consistently good to excellent results in my practice.

Therefore, my short answer is breast massaging once your breasts are hardening is a waste of your time.

Capsular contracture four years postopertive

Capsular contracture can occur many years after breast augmentation. Breast massage at this point will not help improve the hardening. The hardening can progress to the point where the breast implant feels rock hard. Frequently, when the implant gets hard, it tends to displace upward towards the axilla. If you are experiencing pain or discomfort ormyour clothes don't fit quite right secondary to the displacement of the implant then you will likely wish to proceed with surgical correction. You should consult with your board certified plastic surgeon to confirm the diagnosis and to discuss your options.

Todd C. Case, MD
Tucson Plastic Surgeon
4.9 out of 5 stars 55 reviews

Hardening of Breast

It sounds like you are experiencing capsular contracture (scar tissue around your implant).   Unfortunately, massaging will likely not correct this.   You will most likely need a surgical intervention to remove this scar tissue and replace your implant(s).   Please visit with your plastic surgeon to learn more about your options.  Best of luck.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

Capsular Contractures and Massage

Unfortunately, once your breast is firm surgery is necessary to correct a capsular contracture.  Massage and medication will not turn it around.  Once you have had the corrective surgery medication may help reduce a recurrence in the first few months, but there are no guarantees.  Capsular contractures continue to plague plastic surgeons and their patients nearly fifty years after we started using implants for breast augmentations.  We still do not know the precise cause.

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 28 reviews

This is capsular contracture in a fully healed breast; massage is not helpful at this point. You need surgery.

Unfortunately, late, unilateral capsular contracture is usually due to one of two causes: bleeding from some sort of trauma to the affected breast, or bacterial contamination, often from dental work or other source of bacteremia, in conjunction with a minor injury to one breast that allows bacterial "seeding" and formation of a biofilm. Then capsular contracture results in that breast in as short a time as a few days to a couple of weeks.

Regardless of the cause in your case, you now require capsulotomy (at least) or capsulectomy and new implant (at most) to open up your contracted pocket. Your implant did NOT harden--the scar around your implant (your capsule) is what contracted, making your implant feel hard. Unfortunately, even though the implant is intact and not hard, it may well be now contaminated by a surface biofilm, and if reused, may cause anotheer capsule in the surgically revised breast. This is a judgement call made by your surgeon at the time of re-operation.

In patients who are very reluctant to proceed with re-operation (though that is the only definitive solution in the majority of cases), a trial of leukotriene inhibitors (Accolate or Singulair) plus oral Vitsamin E is worthwhile, as it will help soften a hard capsule in as many as 50% of cases. If this works, great; if not, then surgery remains the next recommendation of choice. See an ABPS-certified plastic surgeon experienced in breast surgery for consultation if you have any reservations about your initial surgeon. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Hard breasts at 4 years

If your breasts are firm after 4 years, it is unlikely that any massage will help. It sounds like you have a capsular contracture and may want this corrected.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Capsular contracture

You sound like a typical capsular contracture patient with one hard implant and a soft one on the other side though an exam wiould be essential to say if this is true.  If that is the case, only revisionary surgery will fix this, not massage or medications.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast Massage

Dear Cheekiboon,
Thank you for your post.  In general, once you have hardening or capsular contracture, massage will probably not work.  You may need a capsulotomy or removal of the hard tissue around the implant.  After that, these massage methods may be of help.  See your plastic surgeon for assessment.

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.

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.

Best Wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 47 reviews

Hardening of 1 implant likely capsular contacture.

It would be very difficult to determine what the issue is with that 1 implant without an examination.  That said, the most likely cause of your problem, 4 years after surgery, is whats called capsular contracture.  This is when the scar, which forms around every implant, begins to contract.  As it does, it squeezes the implant inside and makes the implant feel firmer. This can be uncomfortable and there may be some distortion of the appearance of the breast.  I'm not aware that massaging can help with this, but I don't believe it will hurt.  Check back with your plastic surgeon for an examination and options of what is best for you.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 98 reviews

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