Why shouldn't you massage breast implants post BA? There is much contradictory information out.

Question

I see many physicians advising to massage and many advising not to massage post breast augmentation. If the implant has been placed under the muscle what is the reason behind not massaging the breast? Massage is used to prevent contracture, but what causes contracture? Does massage help after contracture has already happened? Will massage make a difference to prevent contracture? I want to learn as much as I can before surgery to make me less anxious.

S. Larry Schlesinger, MD, FACS · Answer

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.

Jeff T. Healy, MD · Answer

There is no scientific evidence that shows that massaging your implants after surgery will decrease the chance of getting capsular contracture.

I tell my patients that if they want to massage their breasts after the first two weeks to help the muscles relax that is fine to improve their comfort.  I tell them to not massage during the first two weeks because it is often painful and could theoretically cause some bleeding if done too aggressively.  If they don't want to massage their implants I tell them fine, because it doesn't make any difference in the long run in regards to capsular contracture.

Kevin Dieffenbach, MD · Answer

Aloha,

Thank you for your very good questions.

If the implant is behind the muscle, it's already being 'massaged' every time you move your arms; which may help prevent capsular contracture. If the implants remain high after the initial swelling, some gentle massaging may be necessary to help them 'drop' into position.

For textured implants, which may also help minimize contracture, massaging is generally not recommended; especially for 'shaped' implants.

I hope this helps. It would be best for you to visit an experienced board certified 
plastic surgeon for an in-depth consultation to review your options.

Mahalo, Dr D

Donovan Rosas, MD · Answer

Massage is one of the clinical points of debate which rages on even today. The initial thought was that by moving the implant within the surgical pocket into which it is placed one can further stretch the muscle assisting the descent of the implant using downward pressure. There is also the contention that this practice can ward offpotential capsular contracture related complications.As we learn more and more about the way in which capsules develop, many plastic surgeons are changing their stance on whether they believe that massage will help or not. There is data which suggests some individuals are capsule formers and others not.There is significant evidence of that use of textured devices decreases the risk of capsular contracture. There are many articles throughout the available peer reviewed literature that attest to this fact. (See: Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials; Barnsley/Sigurdson, Journal of Plastic and Reconstructive Surgery, June 2006).

However, not all patients necessarily need a textured implant. The risk is approximately 10%. Other factors influencing the development of contracture include: implant position (sub muscular < sub glandular), saline vs. silicone (silicone rate is slightly higher, but this may be mitigated by cohesive gels).There exists additional evidence in the literature for the use of leukotriene inhibitors in the treatment of capsular contracture. These drugs are typically employed for the treatment of asthma and use in the setting of a capsule is off label. Typically, in early contractors a 3 month trial has been shown to have some effect on softening. However, an established and organized contracture which has already caused upward displacement of the implant is unlikely to show any improvement.Due to the variability in opinions on the topic, it is always best to follow the recommendations of your board certified plastic surgeon.

Tom J. Pousti, MD · Answer

Thank you for the question.Massage of breasts after breast surgery is not a universally accepted or agreed-upon  principle. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices. I find it quite amazing how adamant each plastic surgeon can be about the superiority of his/her recommendations...

Therefore, once a patient has selected her plastic surgeon, best to follow his/her advise/instructions, as opposed to those of online consultants. Your plastic surgeon knows exactly what procedure was performed, how he/she obtains the best outcomes possible, how you are progressing, and is ultimately responsible for your care. Best wishes.

Why shouldn't you massage breast implants post BA? There is much contradictory information out.

Answers (8)

Answer: Massage post Augmentation...The jury is still out

Answer: Massage post Augmentation...The jury is still out

Answer: Massage of breast implants?

Answer: Massage of breast implants?

Recommended reading

Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.

Why shouldn't you massage breast implants post BA? There is much contradictory information out.

Answers (8)

Answer: Massage post Augmentation...The jury is still out

Answer: Massage post Augmentation...The jury is still out

Answer: Massage of breast implants?

Answer: Massage of breast implants?

Browse related questions

Recommended reading

Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.