Am I Doing the Correct Breast Augmentation Post-op Massage So As Not to Widen Pocket?

The displacement of breast implants is recommended to reduce the risk of capsular contracture. Perhaps that is unproven, but I have seen a few isolated cases where aggressive massage has helped to loosen a tight pocket that has begun to form when displacement was not being performed adequately.

Displacement of breast implants is done for smooth surfaced saline- and silicone gel-filled implants; it is not recommended for breast implants with a textured surface. Smooth breast implants will move freely within the pocket, while textured surface implants do not move -- either because of increased friction caused by the texturing, or capsular adherence to the textured surface.

Medial displacement of your implants is a normal part of the displacement exercise routine – but it will not allow them to move medially, since the medial border of the sub-pectoral pocket is defined (and limited) by the medial insertions of the pectoralis major muscle to the sternum. Nor, will the displacement exercises you have described cause widening of the pocket.

I have my patients begin implant displacement exercises one week following surgery. The acute pain of surgery has subsided by then so the displacement can be done a bit more comfortably.

Displacement Technique:

>> Place your hand flat over the central breast and press the implant inward towards the chest wall. Hold it there for a few seconds.

>> Lift each implant up; with your hand under the implant, slide it up the chest wall slowly, pushing it up towards the clavicle. Hold it there for a few seconds.

>> Push the implant medially; with your hand on the lateral part of the implant, slide it towards the sternum. Hold it there for a few seconds.

>> Push the implant laterally; with your hand over the medial breast, push the implant laterally. Hold it there for a few seconds.

The right implant can be displaced with the left hand, and vice versa. The displacement should be performed slowly and steadily with moderate force. Each displacement should be performed ten times.

Initially the displacement of the implant will be somewhat limited. But as swelling subsides, the tissues stretch, and the implant settles, the implants will move more easily in the pocket. Pain may somewhat limit your ability to move the implants initially, but as this subsides you will be able to displace the implants much more readily.

I only have patients push implants down if I feel they are not settling as intended.

Since there is a thought that these displacement exercises may reduce the risk of capsular contracture, I recommend the following frequency -- Perform these exercises three times daily for six months following surgery, then two times daily for the next six months, and then once daily thereafter. Prolonged use of displacement exercises may be more important for subglandular implants, as subpectoral implants seem to have a lower risk of capsular contracture.

Best wishes.
Kenneth Dembny

 

Dear Jennylea

The massage techniques after breast augmentation has to be done correctly both in specific technique and frequency. The main issue is to perform the massage correctly and frequent enough to obtain the desired result. The massage should start as soon as you are comfortable. Your plastic surgeon should review with you how it is done. Essentially you gently push the implant towards the direction where you want the pocket, hold it inplace for 10 seconds and repeat. Push the implant toward the middle and downward. This is the appropriate direction, and it should be done for 10-20 minutes at a time and three to four times per day. These are the essentials, and it must be done correctly or you will enlarge the pocket especially with saline implants. I find my patients should focus on two things after surgery. One is shaping which is accomplished by using the surgical bra and massage. The other is scar control which can minimize the line.  

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.

Hello Jennylea,

Implant massage has no proven benefits, and I don't ever recommend it to my patients.  It will not prevent capsular contracture and it will not cure a tight or contracted capsule that has already formed.  Massage will not stop or prevent implant malposition toward the sides/armpits.  Saline implants have a propensity to drop with time, more than silicone gel implants, so there is no need to encourage them to drop either.  By this time, your breasts should be taking on a nice shape.  If this is the case, than don't be concerned about what might happen later. If you feel your implants are too far apart or too high, than discuss this with your plastic surgeon.

Best of luck!

I recommend that my breast augmentation patients massage their implants after surgery. I typically recommend they start 2-3 weeks after surgery with this. I recommend they feel the implant at the outer, inferior aspect and squeeze the implant superiorly and centrally. I don't like for my patients to massage the implant outward or downward. The most important thing is breaking up any healing scar around the implant to keep the breasts soft and not allow significant scar tissue to organize around the implant.

There are two reasons why massage to the breasts after augmentation might be recommended. One,as it sounds like you are doing, is to help keep the implants in the right place during the initial healing. Once the scar capsule forms,which takes about 6 weeks, this should no longer be necessary or helpful. The other reason is to prevent capsular contracture, which is a completely unproven idea.

Dear Jennylea,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. 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

I do not think massaging can widen an existing breast pocket.  The tissue does not stretch this easily in my opinion.   I am a big advocate of breast massage.  I like to wait until the first postoperative visit to begin massage for three reasons.  

1.  I do not want excess tension on the fresh incision, which can cause wound healing problems
2.  Massage will increase soreness and I want to get patients off pain medication as quickly and safely as possible.
3.  Early massage can increase the risk of bleeding, which is the number 1 cause of capsular contracture/scar formation.

For this reason, I begin massage therapy at the first visit, which is 4-7 days postop.  I then establish a regimine of 3 minutes of massage 3 times a day for 3 months.
I do prefer a bra, especially in physically active patients, as I find it helps prevent the implant from dropping too much and causing implant malposition.

It is extremely rare to change a pocket after breast implant surgery.  The main goal is to prevent a visible or painful capsule.  If there were technical problems with creating the pocket, overaggressive dissection or muscle release, release of the fold beneath the breasts, a collection of blood or even a mild infection of the implant (which is referred to a biofilm), then an abnormal capsule can result.  At seven weeks, you will not harm the pocket.  

Some doctors recommend displacement exercises and others do not., and still those that recommend them may alter the exercises based upon what type of surgery the patient had performed. Your best bet is to ask your surgeon.