When scar tissue forms is it due to not properly massaging your breast?

Doctor Answers 7

When scar tissue forms is it due to not properly massaging your breast?

Thank you for your question. A scar tissue always forms around the implant since the body recognizes it as a foreign device. This capsule formation is normal and expected. The amount of scar tissue varies from person to person and from case to case. Massaging is said to help prevent capsular contracture, however, it can still happen. I would recommend seeing your plastic surgeon for more information and tips to help you with your recovery. 

Regards, 


Toronto Plastic Surgeon
4.9 out of 5 stars 425 reviews

BREAST AUG SCAR TISSUE

There are many causes of abnormal scar tissue formation following breast augmentation.  The primary cause is believed to be related to excess bacteria in the area.  There is a lot of bacteria in breast tissue, particularly in women with excessive cysts in their tissue.  Bacteria can also be introduced at the time of the surgery, and causes early scar formation following the procedure.  Later scar tissue formation can be caused by remote infections, such as bladder infections or dental abscesses.  It is important to take antibiotics as soon an any infection anywhere in your body is detected in order to prevent abnormal scar formation around your implants.
As to your question specifically, massage is believed to help prevent contracture in some cases and I always recommend it. But I find that abnormal scar tissue formation (contractures) also occur in women who are very diligent in doing the exercises.  This issue has plagued plastic surgeons and their patients since the very beginning of breast augmentation.  The good news is, that in the early days the contracture rate was over 90%, whereas the rate now is generally 5% or less.

R. Scott Yarish, MD
Houston Plastic Surgeon
4.4 out of 5 stars 33 reviews

Breast Augmentation - Massage Concerns

Thank you for your question.  A thin and soft scar forms around all breast implants and is called a capsule. When the capsule becomes abnormally tight and thick, it is referred to as capsular contracture. Massage is believed to minimize the chance of the capsule becoming tight and thick which leads to increased pain and deformity of the device. Please discuss your concerns with your board certified plastic surgeon. Also, make sure you follow all of your plastic surgeons post-operative instructions regarding level of physical activity and use of a support bra. Hope this helps and good luck with your recovery.
 

The utility of implant massage

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.

Scar tissue around implants can occur despite massage of implants

Scar tissue always forms around breast implants. It is natural response to a foreign body by your body. Massage only stops contracture of this scar tissue.  Contracture causes hardening of implants.  However contracture can occur despite massage in some cases.  

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 22 reviews

Scar tissue varies

The amount of scar tissue that develops after breast augmentation is unpredictable.
Massage may help, but even with massage more scar tissue can sometimes develop.

Scar tissue and massage

 By scar tissue, I'm assuming that you mean the natural scar capsule that forms around the breast implant. Despite anyone's best efforts at massage this scar capsule will form around most foreign bodies placed into a human. Massage, especially in the past with smooth walled implants placed on top of the muscle, was thought to keep this capsule larger than the implant enabling it to remain soft. Today, most breast implants are placed below the muscle and in my opinion are auto massaging due to the overlying muscle forces. It may be contraindicated in some heavily textured implants especially those that are shaped to massage. In my practice, I only use massage in the first few weeks to help the implant to descend to the bottom of the pocket and allow the surgical injury of the pectoralis muscle to abate with the stretch of the massage. Find a board-certified plastic surgeon with experience in cosmetic breast surgery in your region and discuss these issues in consultation. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

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