I personally advise my patients to do the massages because I believe it reduces the risk of encapsulation. The pocket created for the implant should be made larger than the implant so the implant can move naturally on the chest wall. Natural breasts are moveable, as opposed to fixed to the chest pointing forward regardless of the patient’s position.
Consider that if a pocket for the implant were made but the implant not inserted into the pocket. The body would heal and the pocket would close. The body doesn’t like unnatural spaces or wounds, so it is natural for the pocket to close. The point of the massages after brest implants is to keep the pocket from closing in on the implant by pushing the implant against the wall of the pocket in every direction.
This keeps the pocket expanded so the implant can move around in the space the surgeon created. The proper term describing the massages is to displace the implant from one side to the other. You must push in every direction: up, down and to each side. The down position is less important because the weight of the implant will do that. The technique is to push straight inward to the rib cage regardless of which direction you are trying to displace the implant.
For instance, when you push inward between the nipple and the lower part of the breast, you are displacing the implant upward, and if you feel the upper pole of the breast, it will be expanded and tight. This stretches the pocket in an effort to stretch the pocket, which is the point of the exercises. These should be done 5-6 times a day for 6 months. More times is better. I have my patients start gently on the forth post-op day. (E. Ronald Finger, MD, Savannah Plastic Surgeon)
“Encapsulation Massage” after augmentation
I stopped recommending routine “massage” several years ago. It isn’t massage, it is really “displacement” of the implant, but it really doesn’t prevent contracture whether with textured implants, as Dr. Stevens discusses, or even with smooth implants.
Several years back, a study by Quebec surgeons showed the risk of massage wasn’t reduced by routine massage; this confirmed what I already felt to be true. My experience had been that despite explicit teaching of massage technique to patients when I put a lot of implants above the muscle, substantial numbers of patients got contractures, and that when I switched under the muscle, regardless of whether or not they did the exercises, the risk plummeted.
Massaging after breast augmentation image
When the Quebec study was published in the Canadian Journal of Plastic surgery, I stopped recommending massage. (Benjamin Gelfant, MD, Vancouver Plastic Surgeon)
The myth of massage
Implant massage is not necessary. Many surgeons have their patients do implant massage (or implant displacement) after breast augmentation yet the reasons for such are unproven and counterintuiative. “Massage prevents encapsulation”
Encapsulation arises from biofilm within the pocket. Biofilm comes from a low concentraton of bacteria and the associated extracellular matrix.
The bacteria do not cause an infecton yet cause the capsule to contract. This is why the axillary incision and peri-areolar incision is associated with a higher rate of encapsulation (the axilla and areola are ot sterile).
Massaging after breast aug
Blood provides bacteria prime nutrients for growth – and so this is why blood in the implant pocket is associated with a higher rate of encapsulation. The dual plane pocket provides a protective effect against encapsulation because less of the breast gland is exposed to the implant (? utility of subfascial pocket).
Minimizing bacterial contamination and growth helps prevent encapsulation. In fact a recent study that followed outomes and several variables found that the patients who did implant massage had a higher rate of encapsulation.
In addition textured implants have a lower rate of encapsulation than do smooth implants, yet no one I know of would have their patients with textured teardrop implants massage or displace them.”Massage keeps the implant pocket enlarged.” Why would one want their implant pocket to be excessively large? The implant should fit within the pocket and not pin-ball around under the breast. Massage is at best unnecessary and at worst counterproductive. (Michael B. Tantillo, MD, Boston Plastic Surgeon)
Should I massage my breasts after breast implant surgery? Ask Dr Ellen
Massaging after breast augmentation photo
I’m a big advocate for massaging the breasts, starting on post op day
1. I instruct my patients before the surgery and begin the massaging when I see them in the office the day after the surgery. I recommend 3x per day and here is why:
1. helps reduce the swelling after breast augmentation
2. helps reduce the muscle and skin tightness
3. helps maintain the “pocket ” dimensions, reduce scar tissue in pocket
3. helps expand the lower pole of the breast and contributes to shape
4. reduces the skin itchiness. Use a moisturizer on your skin!
5. ultimately blends in the incision and any tethering that may be associated with it It can be a little uncomfortable when you begin but quickly makes everything feel better and hastens the recovery after breast augmentation.
The massaging after breast augmentation
I recommend that you have someone help you with this the first time so that you know how much pressure to apply and are reassured that you are not causing any harm. (Ellen A. Mahony, MD, Westport Plastic Surgeon)
Massaging after breast augmentation surgery
I think the most common “bad” experience is not getting the size that you wanted. This happens from insufficient communication between patient and surgeon.
All of the complications you listed are possible but they are rare, non-life threatening, and correctable.
Choose a plastic surgeon that is board cetrified, that has a lot of great before and after photos, and that you connect with and communicate with well. (Remus Repta, MD, Scottsdale Plastic Surgeon)
You are smart to be considering the risks associated with breast augmentation surgery.
These risks include leakage, encapsulation, loss of sensation, interference with mammography, movement of the implants and the probable need for further surgery in your lifetime. You may find the link below to be helpful. (Tom J. Pousti, MD, FACS, San Diego Plastic Surgeon)
Complications and Risks of Breast Augmentation
Satisfaction rates among breast augmentation patients are among the highest of all plastic surgery procedures performed in the United States. Over 90% of patients report satisfaction with their breast augmentation and 95% feel that their appearance has been significantly improved. Despite this high satisfaction rate, there are risks associated with breast augmentation that must be considered before undergoing surgery. Risks of Breast Augmentation Include:
- Postoperative Blood Collection (Hematoma, Requiring Removal): 1-3%
- Infection of the Breast Implant (Requiring Removal): < 1%
- Permanent Increase, Decrease, or Change in Nipple Sensation: ~15%
- 10-Year Re-Operation Rate (for Implant-Related Causes): 25-40%
- Saline Implant Rupture: 5-10% Chance over 10 years (or ~ 1% per year)
- Silicone Implant Rupture: 1-6% Chance over 6 years (depending on type)
- Encapsulation (Requiring Surgical Correction): ~10% Chance over 10 years
- Silicone Gel Migration: Unlikely with today’s silicone implants
- Breast Pain: 5-17% at 5 years
In summary, most patients are extremely happy with their breast augmentation results, but there are real risks associated with the surgery. In addition to educating yourself on the potential risks and benefits of breast augmentation, I also recommend that you choose a plastic surgeon certified by the American Board of Plastic Surgery with experience in breast augmentation.
I hope this information is useful, and congratulations on being proactive and seeking as much information as possible prior to surgery. (Jaime Perez, MD, Tampa Plastic Surgeon)
Breast Implants – Risks, Concerns, Safety
Those are some of the risks. There are risks with all surgical procedures, and risks with everything you do in daily life – including walking across the street, riding a bicycle, etc. It is not possible to eliminate risk, so what you want to do is minimize it and, in the event of a problem of some kind, be prepared for early recognition and prompt intervention.
That combination typically makes complications, which are fortunately rare, even less of a long-term issue. Again, there is no 100% for anything, but those are the basics for getting as close to that as possible. There is a 12 or so page document available from surgeons who are members of the ASPS (the American Society of Plastic Surgeons) that goes into even more detail, and additional documents are available from the implant manufacturers.
They typically list a range of the more common potential complications; I don’t believe that any of them is designed to be 100% comprehensive (ie, it is not possible to list EVERY thing that could happen). Doing good research ahead of time (as you’re doing), selecting a board-certified plastic surgeon and then following the advice and guidelines of that surgeon are your best approaches to safe and successful surgery. (Alan M. Engler, MD, FACS, New York Plastic Surgeon)
The internet is a very helpful tool for information gathering, however, it can also create an immense amount of questions regarding any type of cosmetic procedure. The best way to approach is to see several board cerified plastic surgeons and address your concerns and find the one that you feel the most comfortable with . (Edward J. Bednar, MD, Charlotte Plastic Surgeon)
Breast massage after augmentation prevents encapsulation
I am not certain that breast massage or displacement exercises are all that important. But gentle pushing of the implants up, down, and side to side doesn’t hurt either.
I do not routinely tell my patients to do these exercises, but I have a lot of patients as about it. If they want to do the exercises, I tell them to start doing so when the get up in the morning starting after 2-3 weeks when the chest wall is not sore any more.
Almost all of my implants are placed in the subpectoral space and probably do not need to be massaged. (Asif Pirani, MD, FRCS(C), Toronto Plastic Surgeon)
Encapsulation Massage Methods
My patients are instructed to institute a “massage” regimen 4 weeks following the augmentation procedure. I call these displacement exercises which is a more accurate description of what takes place.
The patient cups the breasts simultaneously and exerts gentle upward and inward pressure for a count of 3 which is then relaxed and repeated 10 times.
The whole exercise is completed in less than a minute. I suggest patients incorporate the exercise into a daily routine such as a morning shower or in bed before falling asleep, that way it is not forgotten. We advise to continue this routine daily for 11 months – to the one year anniversary of the procedure. It is worth mentioning that massage of breast implants has never been shown in a scientific study to reduce the chance of encapsulation. Nevertheless, we continue to have our patients do it as it doesn’t hurt, is easy to do, costs nothing, and may be beneficial. (William T. Stoeckel, MD, Raleigh-Durham Plastic Surgeon)
Breast massage
The point of breast massage is to move the implant around in all directions within the breast pocket. Not all surgeons believe it makes a difference but I do have all of my augmentation patients perform massage beginning a week after surgery. I believe this breaks up any scar tissue that is forming and will allow for a more natural result. I hope this helps. Kindest regards, Neil J Zemmel (William T. Stoeckel, MD, Raleigh-Durham Plastic Surgeon)
Massaging Your Breasts After Breast Augmentation
It is important that you ask your plastic surgeon for instructions after surgery. I normally recommend starting after 3 weeks, and to massage the breasts pretty firmly.
Massage in all directions – from below, above, and also toward midline. (Christopher J. Schaffer, MD, Birmingham Plastic Surgeon)
Breast implant movement after surgery can optimize your result
In my practice, I recommend breast implant movement, done 6 to 8 times per day for one year, starting a week after surgery. This has resulted in excellent surgical outcomes following breast augmentation surgery for my patients for the last twenty years. Breat implant movement is a simple process that takes less than thirty seconds per side.
The implant, not the overlying breast tissue, is pushed toward the midline of the chest, the midline of the neck and toward the collar bone with the opposite hand. The arm and muscles of the side that the implant is on must be relaxed to allow the implant to move without resistance. These movements will keep the space around the implant the size it was created on the day of the surgery, keep the pocket very soft and the breast looking very natural. These movements are done for round implants but not for shaped (or anatomic) implants as it can result in rotation of the shaped implant and a distorted breast shape. (Christopher J. Schaffer, MD, Birmingham Plastic Surgeon)
The term “massage” after BA may not be accurate
While I don’t recommend massage, I do recommend the patient not keep their arms to their sides. Gentle stretching is helpful in not only preventing a general stiffness but it does promote healthy bloodflow and has benefits in minimizing encapsulation. (Neil J. Zemmel, MD, FACS, Midlothian Plastic Surgeon)
Breast massage after breast augmentation
I recommend starting massage a couple days after surgery and try to move the implants around in all directions. Using two hands seems to work best, kind of like you are kneeding dough. (Neil J. Zemmel, MD, FACS, Midlothian Plastic Surgeon)
Breast Massage After Implants
The massaging that is recommended after breast augmentation is really designed to keep the pocket around the implant large enough to allow the implant room to move around. You don’t actually massage the breast itself but rather try to push the implant around in all directions. This can be done as soon as the pain subsides. (Martin O’ Toole, MD, Los Angeles Plastic Surgeon)
Massage implants after breast augmentation
There is no agreement about massage after breast augmentation.
While some plastic surgeons feel that massage is important, and have every woman do it, others do not recommend it. There has never been a definitive study that shows that breast massage is essential. There have been suggestions that massage keeps the breasts soft and prevents encapsulations.
However, this has never been proven. I only advocate breast massage for women who are having sensitivity of their breasts or nipples after surgery. As a routine, I think that the breasts and implants move around in the pockets sufficiently in the activities of daily living. (Jeffrey Rockmore, MD, Albany Plastic Surgeon)
Breast Massage After Implants
“Massage” refers to the “displacement exercises” that you need to do postoperatively. This is VERY important. You push the implant in different directions in order to stretch the pocket that it is in. This helps avoid tightening around the implant (encapsulation) by making sure the pocket stays larger than the implant.
You push the implant in a given direction and hold the position for a ten count (think about how you stretch your calves before running). This can also be used to stretch the pockets in a particular direction to correct minor asymmetries. (Gregory Diehl, MD, FACS, Long Island Plastic Surgeon)
Breast Augmentation Encapsulation Massage
It is important to try to keep the implant pocket from tightening around the implant, which is the reason for massaging. It is much better to have your surgeon, or their assigned staff, instruct you in person on how to appropriately perform the massages, and I encourage you to do so. (Gregory Diehl, MD, FACS, Long Island Plastic Surgeon)
What is proper technique for breast massage after surgery?
First off, breast massage after surgery is anecdotal. There is no evidence to prove it helps or hurts post operatively. I do encourage my patients to begin breast massage after 4 weeks out.
For my patients I teach them to squeeze the implant from its base until you can see it rise toward the collar bone. Pushing them together and down also helps. Performing this in the shower for about 30 seconds per side each day is recommended. (Brian Howard, MD, Alpharetta Plastic Surgeon)
Should I Massage the Breasts After Breast Augmentation
Many patients ask about breast massage post augmentation. Technically, the manuevers recommended after breast augmentation are not truly massaging exercises but are meant to maintain a proper pocket and softness to the breast. There is no clear evidence that this works to prevent any problems and in fact can actually cause a hemotama (blood sack) or more swelling after breast augmentation when performed too early or too vigorously.
Having said that, I subscribe to a quick recovery method of breast augmentation that does not rely on these implant displacement exercises so much. See video! However, even though most patients recover in less than 24 hours from this technique, I still prefer patients to not aggressively displace their implants until 5 or 7 days after.
The types of displacement exercises if indicated should be customized to each breast pocket. Sometimes, these are of more benefit to patients who have tuberous or constricted breasts. This video shows a patient just 4 hours or so post “flash recovery breast augmentation”. She was given only a rotation and downward displacement exercise to do after the 5th day. (Christian Prada, MD, FACS, Saint Louis Plastic Surgeon)