Should you use breast massage after a breast augmentation?

In Ottawa

By Dr. Howard Silverman

I have received a number of inquiries over the years regarding breast massage following breast augmentation surgery. This is commonly recommended on various online forums and chat rooms. However, I do not routinely recommend breast massage after augmentation surgery.  

The logic for doing breast massage after surgery is to either lessen the risk of excessive scarring around the implant, called a capsular contracture, which can make breasts hard and unattractive after surgery; or to alleviate implant malposition. Typically this results from implants being placed too high in the breast during surgery, the use of excessively large implants that don’t fit properly, or from imprecise or inadequate dissection performed in creating the pocket to contain the implant. Let’s discuss each of these issues.

Capsular Contracture

Current thinking and research indicates that capsular contracture occurs secondary to low-grade bacterial contamination of the implant pocket, called a biofilm. The contamination is usually introduced during implant preparation and placement. This can be avoided by sound surgical technique during the operation, involving careful handling of the implant, precise pocket creation, avoidance of bleeding, and a no-touch technique. This means that neither the surgeon or surgical nurse handles or touches the implant during and after its removal from the sterile packaging, avoidance of contact of the implant with the patient’s skin during implant insertion, and antibiotic cleansing and administration. I do all of these things routinely, and as such, have a very low rate of capsular contracture.

Regardless, massage will not avoid development of a biofilm adhering to the implant surface. It may even increase its likelihood by manipulation of the breast tissue itself, which contains small amounts of bacteria normally.

Previous theories regarding capsular contracture evolution related to the concept that scar or capsule formation inside the breast surrounding the implant forms in a linear fashion, which can result in a tight pocket, and that massage and use of textured surface implants would minimize this. I don’t believe this to be the case and current research no longer supports this as a commonly accepted mechanism of development of capsular contracture, so on that basis, I don’t recommend it. Note: Textured implants are no longer in common use due to a small but definite risk of developing an unusual type of malignancy known as anaplastic large cell lymphoma, or ALCL.

Implant Placement

Secondly, if the implants are placed too high in the breast and the pocket has not been precisely created, then the implants may ride too high in the breast, requiring manual manipulation of the breast after surgery to try to push the implant into the correct place. I perform dissection and pocket creation with careful technique and full visualization of the dissection field at all times using lighted retractors, so that implant malpositioning should not occur, and minimal blood is left in the dissected field. I prefer not to depend on chance and imprecise massage techniques after surgery to ensure proper implant placement, so the same recommendation for no massage applies. In fact, the pockets (capsules) around implants usually expand slowly over time, especially with smooth surfaced implants, as the implants move within the breast, and massage can actually make that undesirable pocket expansion more likely.

Lastly, massage can be painful and cumbersome to the patient, and for all of these reasons, I don’t routinely recommend it. I endeavour to make recovery from breast augmentation surgery as simple as possible, and my post-operative instructions usually involve no specific demands on the patient aside from avoidance of lifting and exercise for four weeks in order to allow for proper incision healing.

However, sometimes patients can have focal areas of tenderness and discomfort in the breast while healing, and massage can be helpful for these indications, but I don’t routinely recommend this and would evaluate the patient in person before making this recommendation.

Make sense? I know that there is a lot of conflicting information online pertaining to this subject, but it is my job to stay on top of what works and what does not, so that my patients can have the simplest and best recovery possible.

— Dr. Howard Silverman

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