Will Massaging Implants Two Years Post-op Help to Lower the Higher, Harder One?

This is more than likely capsular contracture which should be examined by your surgeon or a board certified plastic surgeon.  Most likely it will be treated surgically. 

Unfortunately a high, hard breast implant 2 years after surgery is a capsular contracture.  This is a known complication and one that requires a reoperation in order to fix.  When I address this problem I will usually remove the old implants, remove as much of the capsule and scar tissue around the implants, and the place new implants in a different plane.  What this means is if your implants were in the prepectoral plane (above the muscle) I would move them to below the muscle.  This surgery usually requires a few weeks of limited activity but most patients can return to work a few days after the procedure.  Sometimes if a capsulare contracture is suspected early after surgery massage and medications may help but at two years surgery is the only option in order to see any significant change.

Hello Chrissy,

I am sorry but you have capsular contracture.  This is a condition that is not treatable by implant massage, taking asthma drugs or high doses of vitamin E, or using either external ultrasound or infra red devices.  A surgical procedure will be necessary to remove the scar tissue around the implant.  Total removal of the scar capsule and using a new implant will minimize, but not eliminate, the risk of a recurrent capsular contracture.

Although implant massage is recommended by many doctors, there is no evidence that it will either prevent or treat capsular contracture.

In general, minimizing the risk of capsular contracture is achieved by a three pronged system of choosing the appropriate sized implant for your anatomy, performing meticulous, non-traumatic electrocautery surgery, and implant delivery with a 'no touch' technique.  Done well, there is no bruising, minimal discomfort, and a risk of capsular contracture that is one tenth the national average, about 1.5% to 2%.

Please visit a few well qualified and experienced surgeons who have an excellent reputation in revision breast surgery. These doctors will be certified by the ABPS, and are members of the ASAPS.

Best of luck.

 

Unfortunately, I don't believe that massage will be of any benefit. It is best that you consult with the operating surgeon. If you indeed have a capsule contracture, you may benefit from removal of the scar tissue and replacement of the implant. Even with this, you may be at a higher risk for a recurrence of the problem.

Two years out means that your hard implant (capsular contracture) will probably not respond

at this point. It can't hurt but probably will not help much. Are you a smoker? - I ask that question as the risk of harness is up to 30X greater and stopping nicotine would help as would certain medications such as Singulair. However it would be an off FDA usage and you would have to have a thorough discussing and informed consent to use it. 

I suspect that you will need surgery to correct this decision. Make sure you see a surgeon board certified by the American Board of Plastic Surgery with experience in secondary breast problems.

 

It sounds like you have a capsule that formed around your implant and massaging would not help at this point.  I would follow up with your PS.

Massage is not recommended by every breast surgeon, and those of us who DO recommend it have their own timing, method, and reasoning as to how and why it should be done. I believe that "massage" is a misnomer, as I recommend implant movement exercises that are designed to keep the surgical pocket I create in the operating room open and slightly larger than the size of the chosen breast implants. That way, if the scar capsule that forms around ALL implants contracts, there is still "room" for the implant to move and not be constricted, high, tight, and hard (capsular contracture).

Of course, this requires careful surgery and precise hemostasis (control of bleeding points) at the initial surgery, since placing a tight surgical bra or Ace elastic bandage to minimize bruising and bleeding only inhibits implant movement and tends to enhance the possibility of a scar capsule the exact size (or tighter) than the implants, making firmness and potential capsular contracture more likely or worse, When it occurs on one side, it's usually due to bleeding or bacteria stimulating the development of a tighter, thicker scar capsule constricting your implant on that side.

The most common cause of capsular contracture (which is what it sounds as if you have on that "high hard" side) is bleeding, or biofilm formation from "normal" skin or breast intraductal bacteria on the surface of your implant. If your capsule were still evolving (scar immature) over the first 6 months or so, then implant movement exercises could be of some value, but two years post-op means the scar capsule is completely mature and unable to improve. Use of leukotriene inhibitors has been suggested by some to help diminish capsular contracture, and may help in about half of cases, but is much less likely to be of any value at this point.

"Massage" at this point is of little to no value.

My best recommendation is to return to your plastic surgeon, or other qualified, experienced, ABPS-certified plastic surgeons and ask lots of questions. Answers ARE available. Click on the link below for some details that may help your understanding! Best wishes!

Dear Chrissyb,Thank you for your post.  It sounds like you may have developed a capsular contraction.  Massage to lower and soften this breast is not likely to work.  Surgical capsulotomy and repositioning of the implant is needed.  I have my patients follow the below massage techniques depending on the goals we are trying to achieve, but in general, a breast massage technique should be used life-long to try to prevent capsular contraction from occuring.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

Massage will not help a higher and harder implant two years after surgery. You will need surgery to correct this. In general, I do not feel massage is of benefit. Having put in thousands of implants and never having had patients massage and rarely (less than a handful or two) ever seeing hard implant, I do not feel massage really makes any difference. You should see a board certified plastic surgeon to discuss your options.

Thank you for the question.

Based on your description of “higher and harder”, it is very likely that you are experiencing breast implant encapsulation. It would behoove you to be seen by well experienced board-certified plastic surgeons in consultation for accurate diagnosis and treatment options.

Unfortunately, at this stage, it is unlikely that the use of massage and/or medication will be helpful. These maneuvers may be very helpful after revision surgery is carried out.

It will be up to you to do your due diligence in the process of selecting a plastic surgeon  who has significant experience helping patients in your situation. I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.


Then, I would suggest you visit a few surgeons whose practices  concentrate on  breast surgery. Ask  to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.

 You will find,  while doing your due diligence,  that there are many different “specialties” who will offer their services to you;  again, I strongly recommend you concentrate on surgeons certified by the American Board of Plastic Surgery.  

Once you have done your research,  I'm sure you will be able to find a well experienced board-certified plastic surgeon who can demonstrate significant experience to you. At that point, you will feel comfortable proceeding with the revisionary surgery.

Best wishes.