Should Sientra HSC textured implants be massaged?

Question

I had a capsulectomy and implant exchange in January due to grade 4 bilateral CC. My surgeon didn't recommend massages or implant displacement. She said the textured implants should act like Velcro and " stick" to your own tissue. As a precaution to getting CC again I had ultrasound therapy. The nurse insists that the implants need to be massaged and moved. I am getting conflicting instructions. I have started to develop a hard capsule again and don't know whether or not to do the massages.

Richard Baxter, MD · Answer

While smooth implants may need a little help settling into position, textured implants are not meant to move and should not be massaged. However, there is no good evidence that massage helps prevent capsular contracture anyway.

Kevin G. Rose, MD · Answer

You should always follow the instructions of your plastic surgeon, if in doubt I would find another board certified plastic surgeon and get a second opinion.  Generally you do not massage a textured implant, it is possible the nurse performing the ultrasound therapy is not familiar with textured implants.

J. Jason Wendel, MD, FACS · Answer

Thank you for your
question.No, we do not recommend massaging textured breast implants, including textured Sientra breast implants.

To be sure, ask your surgeon specifically.

I hope this helps.

Jed H. Horowitz, MD, FACS · Answer

Care for textured Sientra implantsTextured implants are generally not massaged.   they are meant to become part of the breast capsule and massaging will disrupt that

Richard H. Tholen, MD, FACS · Answer

Textured implants are designed to adhere to the tissues they touch. Any massage or displacement exercises that would be employed with smooth implants are NOT appropriate for textured ones. Your surgeon should always be considered the "final word" as far as advice, as it is s/he to whom you will go if there is another problem, not the nurse who gave you incorrect information.The nurse was no doubt trying to help, but is either misinformed about "massage" and textured implants, or thought you had smooth implants, which would be the majority of implants in use.If you are beginning to again develop capsular contracture, then you should talk to your surgeon, who may wish to consider Singulair or Accolate therapy (luekotriene inhibitors that may block inflammatory pathways that could be associated with your CC recurrence).But NO massage or displacement! These maneuvers are simply mechanical movements designed to keep a surgically-larger pocket larger than the implant it encloses. Obviously, this is applicable only for smooth implants.Let your surgeon know, but don't be too hard on the nurse who was simply trying to help, albeit in misguided fashion. Best wishes! Dr. Tholen

Peter J. Capizzi, MD · Answer

A Biofilm of bacteria on an implant and the body's reaction is the most common modern theory as to the cause and effect of a capsular contracture.  Massage has no efficacy in preventing, curing, or minimizing a capsular contracture.

Joe Gryskiewicz, MD, FACS · Answer

Hi Mottpeyton,It sounds like you have had more than your share of setbacks.  Sorry about that.Keep your surgeon in the loop.  Sientra textured implanted should not be massaged.  The adherence helps prevent capsules. If you are confused, look at your implant labels and call Sientra directly.  Also Sientra is the only implant company who has a warrantee (C3
Program) if you develop a capsule after receiving their textured
implants.  They have a special process which makes the
 texture.  This implant shell is unavailable elsewhere.All the best, "Dr. Joe"

Lars Enevoldsen, MD · Answer

Thank you for your question.  When I use textured implants I draw a "no touching" symbol on the patient's breast.  I do this to make sure that my nurses don't instruct those patients to massage as they would for smooth implants. The idea behind textured implants is, as your surgeon told you, that they stick to your tissues as they heal in place.  By massaging your implants you would prevent this from happening and may as well have used a smooth implant.  I suggest you discuss this with your surgeon and let her know what her nurse told you since there appears to to be a communication breakdown in her office.

Heather J. Furnas, MD · Answer

Your plastic surgeon is familiar with the recommendations of the particular breast implants she placed. She didn't recommend massage, and she explained that the textured implants stick to tissue like Velcro. Textured implants are designed not to be massaged. (You could call to confirm her instructions.)Because the nurse is familiar with patients with encapsulated smooth breast implants, she knows that those implants need to be massaged. However, she is not a plastic surgeon and is apparently not aware of the no-massage recommendation for textured implants. Because Sientra textured implants have such a low capsular contracture rate, it isn't surprising that she doesn't have experience with this type of implant.Unfortunately, no breast implant is associated with a zero risk of capsular contracture. Since you are developing another hard capsule, it would be a good idea to see your plastic surgeon again.

Kamakshi Zeidler, MD · Answer

Sientra HSC round textured implants have a TRUE texture shell with a medium level of texturing. Clinical research on Sientra implants was recently published showing the lowest rate of capsular contracture ever published when their textured implants were placed under the muscle. For these reasons Sientra has a warrantee for capsular contracture that is automatic when you use one of their textured implants and it covers Baker grade 3 (visible) and grade 4 (painful) capsular contracture for patients undergoing first time breast augmentation.Your plastic surgeon has given you the right advice. Texture is like a gentle form of velcro and your breast implant capsule needs to form and grow into the textured surface. This helps the collagen fibers in your capsule stay disorganized so that they stay soft and don't contract around the implant. If you massage the implants, you disrupt this process and lose the possible protective benefit of a textured implant. You should discuss this with your plastic surgeon so that you don't get these conflicting instructions.There are other things that can minimize the risk of developing capsular contracture. Some plastic surgeons use a medication called Montelukast commonly known as Singulair to soften capsules around implants. It is a leukotriene inhibitor, and acts as an anti-inflammatory medication. It is used to treat asthma and seasonal allergies. Though not a lot of research has proven it, many plastic surgeons have a lot of experience using it to soften capsular contracture or to prevent it in patient who starts to feel some tightness. In appropriate candidates, I recommend patients who have capsular contracture take it before revisionary surgery and keep taking it for at least 6 months after surgery. This is an off label use of the medication, and should be used with caution in patients with liver disease. You should discuss with your plastic surgeon if you are a candidate.

Should Sientra HSC textured implants be massaged?

Answers (15)

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