Capsular contractures are an immune phenomenon. Our immune system is relatively primitive, very similar to that of an oyster. When an oyster gets a piece of sand in its shell, the sand is very irritating to the oyster's tender body, and to protect itself against this invader, the oyster puts scar tissue around this piece of sand. Layer after layer after layer of scar tissue is laid down. We refer to this conglomeration of sand and scar tissue as a pearl, and as your know, pearls are very hard. When a foreign body is placed within the human body, be it a splinter in your finger, an artificial hip, a pacemaker, or a breast implant, the body puts scar tissue around it which we call a capsule. Several conditions can cause the body to lay more and more scar tissue around a foreign body leading to what we call capsular contracture which can be as hard as a pearl.To prevent or modulate this immune phenomenon, one must treat the problem at its source. Blood around an implant can lead to hard breasts, therefore all bleeding must be stopped prior to leaving the operating room and a drain needs to be placed in all breast augmentations to decrease the chance of a capsular contracture (CC). Non-pathogenic bacteria (skin bacteria) entering with the breast implant can lead to a capsular contracture, therefore the use of a Keller funnel can decrease the chance of a CC by preventing non-pathogenic bacteria from entering the body. Post surgical dental visits, especially dental hygenic cleaning of teeth, can lead to oral flora entering the body kicking off the immune system, again leading to hard breasts, and therefore taking antibiotics prior to dental visits can decrease the chance of a CC. As you can see, the problem is not a mechanical one and therefore capsular contracture cannot be inhibited and/or treated by mechanical means such as breast massaging. Even the people who believe in breast massaging agree that massaging or displacing implants that are textured is contrary to the reasoning of putting in textured implants. Implants placed under the muscle, if massaged or displaced, can theoretically lead to a larger pocket, and then when the patient lays down, the implants can fall into their armpits. I personally recommended breast massaging for over 20 years of my career because my professors, both at Stanford and Oklahoma, taught me that breast massaging was necessary to keep breasts soft. During that time, I never saw breast massaging ever cure a capsular contracture. Also, I noted that women who massaged their breasts, half of them got hard breasts and the women who didn't massage their breasts, half of them got hard breasts. Therefore, the whole concept, both empirically and practically, of doing breast massaging to keep breasts soft is of no practical value. Breast massaging early after a breast augmentation can disrupt clots on small capillaries leading to bleeding around an implant, which in my opinion, is the #1 way to make breasts hard. In 1963, Dr. Tom Cronin of Houston, Texas invented breasts implants, and although I wasn't there, I'm pretty sure he invented breast massaging because the theory was, in those days, put the implant above the muscle, keep the implant pocket really large so that the walls of the pocket do not move in and surround the implant leading to a capsular contracture. I'm not sure it worked then, but now that we put breast implants in a very small pocket under the muscle, attempts to move the implant around make no sense and can possibly create problems.In short, the only value I see in breast massaging is to transfer guilt from the surgeon to the patient. If the patient didn't do a sufficient number of breast massages each day for the prescribed amount of time, then the formation of a capsular contracture or the elimination of the capsular contracture is on the patient and not the surgeon. LOL.
