Smooth Implants Require Massage for Life?

Question

My surgeon says I have to do massage forever if I choose smooth breast implants while not necessary for textured ones. I am sure any woman would often touch the breasts anyway, but the massage would be more complicated? I hear smooth ones move better but nipples don't synchronize, so it might look unnatural anyway.... Is that true? I am talking about putting them under the muscle.

Jerome Edelstein, MD · Answer

In my opinion, you don't need to massage your breasts for the rest of your life just because you chose smooth ones. In fact, I don't even recommend massage for most of my patients, even right after their surgery! You can achieve beautiful, natural looking results with smooth implants or textured - it is the skill of the surgeon that counts more.

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.

Rod J. Rohrich, MD · Answer

The care for all types of breast implants above or below the pectoral muscle, in my professional experience, is to do massage at least for the first year once or twice a day methodically. After that, it really does not matter significantly. In primary breast augmentation, I do use Smooth saline or silicone implants in a vast majority of cosmetic breast augmentation patients because they look and feel more natural when placed beneath the muscle.

Richard Baxter, MD · Answer

Firstly, when you have a plastic surgeon you trust then you should go with his or her advice, but in my opinion there is no benefit to implant massage in most cases. A scar capsule normally forms around the implant, and it may be helpful to massage during the first couple of weeks as the scar capsule forms, but there is absolutely no evidence that it prevents capsular contracture. We use smooth implants routinely because they often feel softer and move more like a natural breast but I don't advise massage. It's more a matter of opinion than science.

Otto Joseph Placik, MD · Answer

See VIDEO BELOW for instruction.
	Breast massage is advised to maintain the immplant pocket, suppleness of the augmented breast and minimize capsular contracture. They may be discouraged in patients with excessively lax implanted breasts. See VIDEO BELOW for instruction.

Pablo Prichard, MD · Answer

Dear Meisa,Thank you for your post. Unfortunately, smooth implants have a tendency to to widen, especially when placed under the muscle because the muscle is constantly pressuring them to go in that direction.  That being said, following these techniques will prevent you from helping them along.  How far they widen or if they widen depends somewhat on how aggressive you body produces a capsule around the implant and how strong that capsule is.  You may be luckier or less lucky. Whether or not you have smooth or textured implants, however, you should follow some sort of massage technique.  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 natually 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.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

Steven Turkeltaub, MD · Answer

The risk of hardness developing around implants behind the muscle is fairly low and significantly less than those place above the muscle. Despite unclear scientific evidence on "massaging" your breasts to lower the risk of capsular contracture, I instruct all my patients to perform this exercise and believe that it can make a difference.

	In the early postoperative period, it is my opinion that this is the most important time to perform it and I have my patients initially do it several times per day. With time, it can be reduced to once a day which should not be inconvenient for most women. Longer term, it may not be necessary particularly with more active women.

Darryl J. Blinski, MD · Answer

You need to see in person a PS to discuss all these issue about breast implantss. From MIAMI Dr. Darryl j. Blinski

Peter E. Johnson, MD · Answer

Breast implant massage is an ongoing area of debate, and the actual benefit is unproven. We believe that submuscular placement will help keep the implants soft, and it is best to shape the pocket to fit the implant, and keep the breast still during recovery to allow the implant to meld and form with the breast. Massage is unlikely to prevent capsule contractures, and is of modest benefit once capsules have developed. Massage to expand a pocket? Again we prefer a soft implant with a 'hand-in-glove' fit as the breast and implant should move and feel as one.

	Best of luck,

	peterejohnsonmd

Steven Wallach, MD · Answer

Although there are no strong scientific studies supporting that massage is better than not massaging with implants, I recommend it to my patients because I think it keeps the pocket open.

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