Textured Unders + Massages- Will This Prevent Capsular Contracture?

Hello, been looking around here but I do not seem to find a proper answer to my relatively simple question. >>Does massage /manipulation help against CC when having TEXTURED sylicone implants? (under the muscle) . Is it necessary or can it even considered a waste of time? <<. Thank you so much , C

Doctor Answers 10

Massage Technique for Breast Augmentation

Dear cricricri11,
Thank you for your post. It depends on what the purpose of the massage is. If to help prevention of capsular contraction, then this should be done for the life of the implants. Unfortunately, capsular contraction can happen at any time, even 10 years down the road, whether or not you have smooth or textured implants, however, you should follow some sort of massage technique. Certainly with textured implants if the massage technique is done too aggressively or incorrectly, then you can detach the tissue ingrowth to the textured surface.  Massage is not a full proof prevention of capsular contracture, but it helps. If you are doing massage for positioning, then follow below.
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

Phoenix Plastic Surgeon
5.0 out of 5 stars 48 reviews

Textured implants were designed to go over the muscle and not be massaged.

The idea behind using textured implants is that the tissue adheres to the textured surface of the implant. Massaging will disrupt this process.

If the implant is placed under the muscle then it should have a smooth surface, in this case massaging will interrupt the growth of the capsule around the implant. Some doctors recommend laying on your stomach and chest as a way to further move the implant around and help avoid capsular contracture.

Vitamin E has also been advised by some doctors as it is thought to soften the collagen in the new tissue growth although there is no empirical evidence to support this. It should not be taken prior to surgery or immediately after as it thins the blood.

Studies have shown that when placing the implant under the muscle there is very little difference between textured and smooth in the rate of CC.

Sofia K. Kirk, MD
Jacksonville Plastic Surgeon
4.5 out of 5 stars 37 reviews

"Massage" is NOT recommended for textured implants!

This is a simple question that is commonly asked. Textured implants are designed to "adhere" to tissues much as Velcro does. Most textured implants are used above the muscle, as they were designed to isolate possible bacterial contamination from ductal bacteria, as well as to "break up" the linearity of collagen bundles (the scar capsule your body forms around every foreign body--your implants), decreasing contracture. Smooth implants induce a smooth capsule, which more easily contracts. Textured implants (above the muscle) do reduce the incidence of capsular contracture over smooth implants above the muscle. BUT, they are thicker, have more-readily-felt edges, and (if saline) have an increased likelihood for leak and deflation.

Under the muscle implants became common after the FDA restrictions on silicone gel implants, when use of saline implants above the muscle more commonly showed visible rippling, edges, and simply felt too "water-balloon-like." So most surgeons went below the muscle, decreasing the high, firm, round, "Baywatch" look, and coincidentally noting a lower capsular contracture rate.

But textured implants below the muscle make less sense, since there are much fewer disrupted breast ducts, and a bit of implant movement is much more natural compared to immobile, firm, "coconuts." Also, many textured implants are "shaped" or "anatomic" teardrop implants that need the texture to adhere and prevent malposition or rotation (imagine an upside-down teardrop implant).

"Massage" (more properly called implant movement exercise) is designed to keep the implant pocket larger than the implant, reducing the likelihood that even a bit of capsular contracture would result in a firm breast. If you "massage" a textured implant, it is not being allowed to adhere properly, and you could end up with a smooth healed pocket and an upside-down or sideways implant!

So, below the muscle placement should require smooth round implants. Textured implants are inappropriate for submuscular placement, IMHO. Though not true in every case, I suspect that use of textured implants below the muscle are the recommendation of surgeons who are not ABPS-certified, or those with less experience. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Capsular Contracture


Textured implants have only shown a small benefit in reduction of capsular contracture when placed over the muscle compared to smooth implants in the same position. Submuscularly placed implants enjoy a lower rate of contracture compared to any implant over the muscle, and textured implants do not reduce that rate further, so therefore texturization is not necessary.

Massage has never shown to prevent or treat capsular contracture, yet many surgeons still tell their patients it is important.

Reduction of capsular contracture and all known complications of breast augmentation begins with your choice of surgeons.  Surgeons who adhere to an anatomic based sizing system will give you the most appropriately sized implant for your body, minimizing complications associated with inappropriately sized implants. Meticulous electrocautery surgery that minimizes collateral injury to tissues will further reduce risk. Finally, a no touch technique of implant placement utilizing a purpose built funnel, will minimize inadvertant implant contamination from skin and or milk duct flora.

Secondary gains from these techniques are minimal pain which is controlled by Motrin, the ability to move your arms overhead the night of your surgery, absence of bruising, and returning to all normal daily activities in 24 to 48 hours for a majority of patients.

Best of luck!


Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Benefits of textured implants

Your question is not easy to answer without an examination or photographs. There is certainly not once size or type of implant fits all. Some women are more appropriate candidates for smooth walled implant while other are better candidates for textured shaped anatomic implants. It you have sufficient soft tissue to cover the implant and you have a normal distance from the inframammary crease to the nipple then a smooth walled gel implant will be fine. But if you have a short distance from the nipple to the crease, in the 3 to 5 cm range and the only shape of the breast is the implant then a round implant will look round and not as natural as an anatomic implant. In some individuals I believe that the shaped textured implants will prevent complications such as a double bubble or bottoming out and malposition because the texturing helps the implant stay where you want it. The dissection for a shaped device is much more meticulous than with a round device since a shaped implant must fit in like a hand going in a glove. I use both smooth and textured implants. The procedure must be individualized and your plastic surgeon should have experience using both types so that you can get the optimal result. I find one of the biggest differences between a smooth implant and a shaped implant is that with a shaped implant the implant shapes the breast and not the other way around. Educate yourself about both types and make the best decision with the help of your plastic surgeon.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Better not to massage textured implants

When textured implants are used, it is important that the texturing on the implant integrates, or attaches to, your own tissues. Massage will interfere with this and could lead to fluid collections called seromas, or rotation of a tear-drop (anatomic) implant. It will also not prevent capsular contracture.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Breast implant massage does it decrease capsular contracture?

I would not recommend implant massage with textured implants.  There is more opinion as to the benefit of massage than real knowledge.

Craig Harrison, MD, PA
Tyler Plastic Surgeon
5.0 out of 5 stars 32 reviews

Implant texture can reduce capsular contracture risk

We do know that capsular contracture can be reduced both by submuscular placement, and texture on the implant surface. A decade ago manufacturers developed all types of texturing from coarse to mild under such names as siltex. Texturing may have reduced implant life, and caused fluid or seromas for some, and currently seem out of favor. Massage for a textured implant is not recommended. Best of luck

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 43 reviews

There is no miricle cure

Capsules happen no matter what type of implant and no matter where it is placed. It is a problem with the operation we have not found a cure for.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Textured implants and massage

Textured implants usually incorporate to the local soft tissues to presumably  decrease the risk of a capsule formation.  It usually is not recommended to massage them.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.