Massaging after Breast Augmentation, why do some doctors recommend this and other don't?

Question

How come some doctors recommend to do massages and others don't after surgery during the healing process?

Edwin C. Pound, III, MD · Answer

The idea of doing breast massages is to keep the breast pocket soft and inhibit the formation of scar tissue that can thicken causing capsular contractures.  When the implants are placed below the chest muscle, the natural movement of the muscle over the implants as you go about your daily routine massages the implants.  When implants are placed above the chest muscle, you lose this automatic muscle massage.  In that case, manual massages become more important.

Young R. Cho, MD, PhD · Answer

Thank you for your question.If you find that your breast is tight and particularly if you went up a few cup sizes, then breast massage will help your implants settle.  I typically recommend waiting a week as it sooner may be too uncomfortable.  However, if you can tolerate it earlier, then you can do so.  I also recommend lymphatic massage as this helps to reduce swelling much faster in the breast.As far as how to massage, I recommend displacing the implant in all four directions (up, down, left and right).  Example, pinch the breast on the top to displace the implant downwards.  For the lymphatic massage, it is much more of a light gentle touch.  We often recommend a massage therapist to help with this or we show patients how to do this at home.  You can repeat this several times a day for the first several months.

Tom J. Pousti, MD · Answer

It is very common for patients to find that different plastic surgeons have different ( and often very strong) opinions about the best way to manage specific patient care issues. It,  therefore would be in your best interests to call your plastic surgeon's office and find out what his/her practice protocol is. Otherwise, if you seek postoperative care advice from online consultants, you will likely end up confused...Best wishes for a  uneventful recovery.

Pablo Prichard, MD · Answer

Dear BH,Thank you for your post. Massage depends on what you are trying to achieve.  In general, even if the implants are positioned perfectly, even if they are texture, even if they are anatomical, I still recommend light massage as in #4 as keeping the capsule that forms around the implant soft a pliable, I believe can help prevent capsular contraction.  I included my massage techniques to show you what massage can and can't do.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. If the massage is done incorrectly, or past the point of symmetry when trying to lower an implant, then yes, it can cause bottoming out or widening. Follow these guidelines to avoid this. Your implants will get softer naturally as the swelling goes down, so you should always follow your particular doctors recommendations regarding massage. These are the instructions I give my patients: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. If done indiscriminately then you can go too far and bottom out. Make sure you are paying close attention and stop once the desired contour or position is reached. Once this is reached, I recommend good support with an underwire bra that hits you precisely in the crease that was made while positioning the implant.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

Richard J. Brown, MD · Answer

It can be very patient dependent. There are some patients that I am happy with where the implants sit the day of surgery and I do not want them to move the implants around. Some I want to encourage the implants to move. But, I do like some gentle massage for everyone to keep the breast soft. This is such a subjective thing for each surgeon. There are not hard fast rules or research that says you have to massage or your results will be less. I wouldn't focus on it too much. Just ask your surgeon what they want for you.

Robert S. Backstein, MD · Answer

The concept behind breast massage after augmentation is that nudging the implant around via massage prevents the natural scar tissue layer that forms around the implant from setting in too tightly (i.e. capsular contracture). There are no good studies that document that this is effective and I personally don't recommend massage for fear that if it's done too aggressively a true hematoma could be provoked or even just some minor bleeding that could actually increase the chances of capsular contracture down the road.

Louis DeLuca, MD · Answer

Thank you for your excellent question.  Breast massage after augmentation is one of the most common questions asked by patients in the early post-op period.The idea behind breast massage after breast augmentation is that it keeps the implant pocket (which is ultimately formed by scar tissue encasing the implant) soft and pliable.  Massaging the breast is thought to 'break-up' any scar tissue that is beginning to get a bit thick (Every implant will be surrounded by a breast capsule.  Most breast capsules formed by scar tissue...a normal occurrence, is very thin and thus never noticeable to patients or doctors).  Many plastic surgeons believe this to be true and thus encourage patients to massage their breasts after augmentation.Other surgeons, however, do not believe that massage has any benefit in reducing the possibility that the breast will get firm (indicating thick scar tissue has formed around the implant). Furthermore, some surgeons also believe that massaging the breast after augmentation may increase the possibility of the breast becoming firm by stimulating the formation of thick scar tissue.While the controversy over breast massage remains unresolved, breast augmentation remains a procedure with one of the highest rates patient satisfaction.

Massaging after Breast Augmentation, why do some doctors recommend this and other don't?

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