Why do many surgeons recommend bandeau and breast massage post-op?

Question

I'm seeking some real input from surgeons on post operative interventions. I’m surprised by the variety of opinions on various post operative interventions such as wearing the bandeau and breast massage. I understand they are not exactly evidence based. Why then, do I many surgeons recommend them? From a patient’s perspective this seems like a way to put at least some of the responsibility for the surgical outcome on the patient. Isn’t the adequacy of the surgical technique really the only thing that matters?

Terrence Scamp, MBBS, FRACS · Answer

Hello there Surgeons tend to use the methods that work best in their hands . Some of these things are backed by hard science and some are just observations .I personally don't use massage or bandeau ; these were more common with the armpit approach to augmentation which has fallen out of favour due to the higher complication rate .So I can't really justify these methods to you .There is more to it however than just surgical method . Why does one person get a problem when they are treated exactly the same way as the others who didn't ?These are things we don't know .CheersTS

Martin Jugenburg, MD · Answer

Thank you for your question.I understand your concern. Every surgeon has different post op protocols based on his/her experience. Breast massage varies patient to patient. The idea behind breast massage to help stretch the skin to allow the implant to drop. Please follow your PS instructions and speak to him/her if there are still concerns.You may learn more on our social media (Instagram and Snapchat): @realdrsix.
  
Best regards

Sacha Obaid, MD · Answer

Thank you for your question! For my patients, I recommend they start massaging the breasts at 1 week post op, to help the implants settle into their final position faster. It also helps to keep them even if one breast implant starts settling before the other. The length of time for each patient to massage varies, based on the position of each patients’ implants and their own personal preference. I recommend consulting with a board certified plastic surgeon and discussing specific post surgical recommendations. Best of luck!

Carolina Restrepo, MD · Answer

Thanks for your question. Every surgeon will have his/her own preferences as to recovery for specific procedures.  I have patients wear a soft bra after breast augmentation for a few weeks to splint everything, and at that point the scars are generally very stable and we move to normal bras (or none) and long term scar management. The best person to advise you whether you should massage or not would be your specific surgeon.  Breast augmentation is a very powerful technique in the right hands, and can have dramatic results in a variety of breasts types.  Most important is a consultation with a Board Certified Plastic Surgeon regarding this procedure.  Don’t settle for less!

Daniel Barrett, MD · Answer

Dear bckwdsbrbie,every plastic surgeon has his own postoperative protocol which he recommends to his patients. A lot of it is based on previous experience. I would suggest you to discuss this with your plastic surgeon.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Robert M. Tornambe, MD · Answer

I completely understand the confusion however each surgeon has their own particular protocol after each operation because they have found it effective in reaching the best possible outcome for their patients. Personally, I recommend breast massage, or basically moving the implants within the pocket daily, starting one week after surgery, because statistically in my patients, this greatly reduces the incidence of capsular contracture. Simply put, those of my patients that massage their breasts daily have a better outcome and softer breasts. The band is sometimes used if the implants are riding higher, but I personally do not use it on every patient. Consult with a board-certified plastic surgeon in your region and voice your concerns. Good luck.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  Each surgeon uses their experience over years of practice to recommend those techniques that they feel get the best surgical results for their patients.  Implant displacement exercises are certainly one where opinions vary.  Though data shows that they are not effective they were thought in the past to limit the chance of capsular contracture, while softening a patient's results.  I agree with you that most results are dictated by what occurs during surgery, but the ultimate question is how each patient heals afterward as some are more prone to scarring then others.  Hope this helps.

Ajaya Kashyap, MD · Answer

Thank you for your question.
A lot of what is done and practiced is based on experience rather than evidence based medicine. The results may be improved by patient participation with measures like massage, pressure garment, exercise, using silicone gel sheets etc. Some of these may not make much of a difference but would not hurt. All The Best !

Christine Blaine, MD, FACS · Answer

Thank you for your question.  Every surgeon has their own protocol, so unfortunately there is no universal rule when it comes to these post-operative garments.  Generally speaking, the only garment that I require (and ask) my breast augmentation patients to wear post-operatively is a light weight surgical compression bra (with straps and front closure).  Some surgeons do recommend the use of a breast strap (what I believe you are referring to as the bandeau) to help with the settling process.  In my practice I have not found the need to use these straps but my technique and experience in practice might be different than that of others who do recommend their use.  Breast massages are a more common post-operative instruction, in my opinion, as the theory is that the movement or displacement of the implant within the breast pocket will help to prevent capsular contracture and can help to keep the implants soft and natural feeling.The best advice that I could give you is to discuss your plastic surgeons post-operative instructions with him/her directly.  There is no guideline with respect to post-operative care so each one of us Board Certified Plastic Surgeons makes our own decision as to what we believe will provide our patients with the best cosmetic result.  I hope that this helps!

Karen Leong, MD · Answer

Hello, great question! Unfortunately the only consensus statement you will get from surgeons is that every surgeon's protocol is different!You are right to say that each individual's need differ after breast augmentation. And this changes even more if there is a breast lift performed at the same time. You may even find that some surgeons advocate wearing a bra and others say never to wear a bra.Honestly, it's all based on the surgeon's personal experience and/or training. I think most would agree that if massage is encouraged, the thinking is to keep the pocket open so that the implant does not crimp or form scar in a way that would deform the breast or cause the patient discomfort. Bandeaus may be used by some if the implants are riding high or not dropping into the pocket in a timely manner. In the same way, some surgeons encourage underwire bras if they feel the implant is dropping TOO quickly to "set the crease" and prevent bottoming out. In essence, these are all nonsurgical postoperative maneuvers to manipulate scar formation for the best outcome.I hope this helps! - Dr. Leong

Why do many surgeons recommend bandeau and breast massage post-op?

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