I Recently Had my Implants a Little over 3 Weeks Ago. I Know I Should Be Massaging Them More Than I Am?

Question

They are very tender. Now that I am back at work. I can't sit at my desk massaging them. So I wait until I'm ready for bed and massage them then. someone had told me that If I don't massage them. The implants will never drop. Is this true?

Kenneth Hughes, MD · Answer

Implants do tend to drop over time. However, larger implants in smaller women definitely benefit from massage. The goal of massage is to get the larger implant to drop into the pocket that has been dissected during surgery. No one wants to undergo another procedure to allow the implant to drop.

S. Larry Schlesinger, MD, FACS · Answer

You trusted your plastic surgeon with your looks and your life.  I would recommend following his or her post surgical massage protocol. 

	That being said, in my practice, I do not believe breast massaging will lower implants, nor do I believe it will make them softer.  When I was in my residency, I did a personal survey of all my breast augmentation patients.  Of those that were willing to massage, half got hard and half stayed soft.  Of those who thought breast massage was a waste of time, half got hard and half got soft.  Therefore, in a very anecdotal way, I made the decision that breast massaging had nothing to do with whether breasts got soft or not.  Hardness of the breast is related to the body's forming a capsule around the implant.  If the capsule is thin and fine, your breasts are soft.  If the capsule is thick or rigid, your breasts feel hard.  This has nothing to do with the breast implant.  It has to do with your body's response to a foreign body.  These same exact comments can be applied to a pacemaker, artificial hip, or any other foreign device within the human body. 

	As to whether massaging brings your implants down, this may be true of implants above the muscle.  I am not sure because I do not put my implants above the muscle.  As far as breast implants below the muscle, I believe proper placement is the key, and if the implants are actually placed too high or they migrate upward, then no degree of massaging will ever assist.  I place my implants in the partial subpectoral space, and immediately after surgery, have my patients wear an ace wrap to keep them from migrating upward.  I also recommend not wearing a bra for one month after surgery because bras are meant to push breasts upwards, which is exactly the direction you do not want your implants to go in.  I believe the ace wrap worn 24/7 except when showering gives more consistent pressure in a downward direction and trumps intermittent massage no matter how often one massages.  I believe the higher placed appearance in the early post operative period is due to silicone being displaced upward within the implant covering, and silicone position can be aided in moving downward with the constant pressure from a high positioned ace wrap.  Also, the initial space created between the chest wall and the skin at the base of an implant pocket  is V-shaped in nature, and the bottom of the implant is bull-nosed (rounded), therefore constant pressure on the implant helps stretch out the V at the bottom of the breast, and that may be the dropping of the implant into the pocket that some surgeons refer to. 

	With reference to breast massaging to decrease the firmness of hard breasts, that theory first proposed by Tom Cronin, M.D. in 1963 was the best they could come up with in those days, but doesn't hold water today because most hard breasts early on are capsules around an implant, and only in a Baker 4 situation does the implant not move due to capsule strands going out into the breast tissue.  Therefore, moving the breast implant around with a hard capsule around it doesn't make it any softer.  It just decreases the chance of going from a Baker 3 to a Baker 4. 

	The problem with hard breasts is one of an immune response and one should treat an immune response with something that modulates (i.e. decreases) some portion of the immune response, and the mechanical manipulation of a breast implant will have little or no effect on decreasing the immune response which is the basis of a capsular contracture.

Naveen Setty, MD · Answer

Thanks for your question. Postoperative protocols for any type of cosmetic surgery can vary quite a bit between different plastic surgeons. That usually means that there is no consensus on the best method. This is true with breast massage after an augmentation. In my practice, I do have patients do massage after augmentation for a few weeks after an augmentation to help soften the pocket and help the implants settle. If my patients did not massage, I imagine the implants would still settle but it may take a little longer. If your implants were placed below the muscle, they are getting a little bit of a massage every time your muscle contracts. Talk to your surgeon more about your question. Good luck and congratulations on your surgery!

Norman Bakshandeh Day, MD, FACS · Answer

i dont think that massage has very much to do with the final position of the implants. Aggressive massage may help correct minor issues but most of the healing is determined by your bodies healing process which is very individual.

Stephen M. Lazarus, MD · Answer

Hi Mariah,

	It may take 6 weeks for the initial softening and settling of the breast to occur. There are several factors that affect the "drop time" :

	
		Location of the implants (over or under the muscle?).
	
		The shape and firmness of the breasts before surgery.
	
		Size of the implants.
	
		How tight or loose the breast creases are at the tme of surgery.


	Although the majority of breast implants will likely drop whether you massage or not, I will often recommend exercises ("massage") and/or the use of an elastic band over the top of the breasts to encourage settling.

	Ask your PS what is best for your particular situation.

Tom J. Pousti, MD · Answer

You will find that every plastic surgeon has a different view on the importance of massage after breast augmentation surgery; generally speaking, you will be best off following your own plastic surgeon's advice in this regard.

	In my practice, I do recommend gentle breast massage that helps breast implants “settle” into their pockets. It may be that the massage/movement of the breast implants helps the  the breasts soften as well. Again, however best to run this question by your plastic surgeon.

	Best wishes.

Brian Howard, MD (retired) · Answer

Good question and thanks for posting. Although the plastic surgery literature actually has very little high quality science to prove the value of breast implant massages, there are some good intuitive reasons to make us believe that it does provide some value. In my practice, my patients start massaging one week after surgery (as tolerated due to the discomfort early on) and then become more aggressive with them as the discomfort fades. In my experience this does help to expedite implant dropping. It's important to massage symmetrically to keep the implants even as they drop, so at times it means massaging downward harder on one side than the other. Whether or not is has any measurable influence on preventing capsular contracture is not proven. Best wishes!

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