When is It Too Late to Start Breast Massage After Augmentation?

Question

I am 5 months post op breast augmentation. I am 28 years old, had 350cc silicone HP Mentor textured implants sub-glandular. (was a large A / small B) My PS told me by 3 months they would be in the final position and at the final firmness. She checked at 3mnths said the capsule was forming normally, no cc. However they are still really hard. I did not do much massage as they are textured, but exercise daily. Will they A) Still soften? and B) If I start massage now is it too late?

Vincent N. Zubowicz, MD · Answer

There is no evidence that massaging the breasts has any benefits after breast augmentation. Early on it should probably be avoided.

Jerome Edelstein, MD · Answer

Massage is generally advised for my patients. I find it unnecessary. It is normally not advised for textured implants either. You may want to ask your surgeon about how you dislike the firmness and what you can do to help soften it.

Pablo Prichard, MD · Answer

Dear kayteetoo,thank you for your post.  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.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.In your case, if your breasts are getting harder, then you may be developing a capsular contracture.  Once the CC develops, then massage will not work.  Its better for prevention, but this is not full proof.  You may need a capsulotomy with immediate starting of massage as well as medications to help prevent this from happening again.  Visit your plastic surgeon to be assessed.Best Wishes,Pablo Prichard, MD

Steven Wallach, MD · Answer

First, not all surgeons believe in advising patients to massage. Second it is only really recommended for smooth implants.

Joseph L. Grzeskiewicz, MD, FACS · Answer

At 5 months post op your capsules are likely mature with respect to both tightness and position, and thus massage at this point is probably fruitless. In addition to that, although the Mentor texturing is not a "high pile" texture and you won't see tissue ingrowth with it, we typically don't have our patients with textured implants massage. In addition to any effects that texturing may have on preventing capsule contracture, it will also add to the friction between the implant and the tissues, and if your implants are too high at this stage of the game, they were probably always too high, the texturing would have prevented any significant "dropping" over time, and the only way at this point to position them more appropriately is to do it surgically. If you have capsule contracture, you can take a medication to help soften the capsule, but it still is unlikely to cause the implants to physically move. The only way to determine whether you have capsule contracture or not is to have an exam by your surgeon. Even with textured implants that can still occur unfortunately, so I think it needs to be considered. At this point the main question to ask yourself is what is bothering you about the breasts. If it is the position of the implants, then you should really prepare yourself to undergo another procedure to correct this if it bothers you enough. If, on the other hand, it is firmness, it may be worth a trial of Singulair to see if the capsules will soften at this point, but if they don't, then you will need a surgical capsulectomy to address the problem. Either way, I wouldn't hold out much hope that massage will be the magic bullet, as it probably wouldn't matter one way or the other.

Todd C. Case, MD · Answer

You can massage your breasts if you like, but this will not likely influence whether you develop capsular contracture. I do not think you can do a randomized double blinded study to see if massage makes any difference. How hard to push, how many times a day, for how long, are you a smoker, have diabetes etc. Also, capsular contracture can occur a year after surgery or thirty years after surgery, so do you need to massage for the next thirty years? No one really knows. I do not have patients massage their breasts, I can assure you that I rarely every see a patient develop capsular contracture with having placed several thousand implants.

Jourdan Gottlieb, MD · Answer

They may still soften

	It is not too late to start massage. 

	Check with your surgeon, as there seems to be a disconnect between your idea of soft and your surgeon's. It may well be that you are expecting something softer than may be possible. For example, the breast can't really feel softer than the implant itself.  As her next visit if the implants feel soft, noting that to you they feel firm. All the best.

George J. Beraka, MD (retired) · Answer

Hi.

	I am sorry to tell you that breast implants are not going to get better.  And massage does not help, early or late. I am not sure why they are hard, but probably capsular contracture.  In any case I think revision will help.

Robert E. Zaworski, MD (retired) · Answer

It is not too late to start the breast massages, but it is very important to follow up with your Plastic Surgeon to make sure that you do not get capsular contractures. You need to know how the breast are suppose to feel in case of any changes. Best wishes!

When is It Too Late to Start Breast Massage After Augmentation?

Answers (9)

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