There is a controversy as to whether or not breast implants should be massaged following surgery. In order to answer this question, we need to examine 2 factors:
- The steps of the breast augmentation procedure
- The differences between textured and smooth implants
A breast augmentation at my Bloomington, IL practice is typically done below the pectoral muscle (submuscular) is one in which a pocket is developed beneath the breast, above the chest cage, between the sternum and the lateral border of the pectoral muscle, just before the armpit. This pocket needs to be large enough to accept and contain a breast implant.
The breast implant itself is typically an envelope filled with saline solution or silicone gel. In my practice, we typically use saline implants; however, these guidelines are applicable to both silicone and saline. Neither saline solution nor silicone gel can harden on their own. However, certain augmented breasts can sometimes become firm or hard, a complication known as capsular contracture.
So why does capsular contracture happen? Any time a foreign object, such as a breast implant, is placed in the body, the immune system forms a sac-like capsule around it to isolate it from other body tissue.
Sometimes the capsule that is formed becomes tight over the implant. This can happen even if the capsule is not very thick. If the capsule tightens around the implant, this can result in a firm, sometimes even distorted breast.
We actually demonstrate this phenomenon to our patients by placing a piece of tissue on top of an implant and putting some pressure with the tissue over the implant. This will make the implant feel hard, since it does not possess enough room to move freely. This demonstrates that it is not difficult to make an implant feel firm or hard if even a thin capsule becomes snug.
Massaging will prevent the capsule from becoming “tight.” I ask my patients to perform 3 breast massage exercises to help prevent this from occurring. This is done by moving the prosthesis up, down, towards the sternum, and towards the armpit. When one does this consistently, there is more room inside of the pocket for the implant to fit in. This keeps the implant feeling soft. This is good for two reasons:
- The breast feels more natural
- The implant moves freely inside the pocket, allowing the implant to move as a normal breast would
A normal breast shifts with everyday chest movements. This “wiggle” is desirable, especially compared to a breast that is fixed to the chest wall and it looks fake, abnormal, or overly firm.
While we don’t know why some implants become firm in some people and not in others, we do know that allowing the implant to “live” inside of a pocket that is wide will encourage the implant to feel softer than it would if the pocket was tighter. This simple reasoning is the answer as to why it is not only desirable but also necessary to massage an implant after breast augmentation surgery. There really are no drawbacks or risks to massaging an implant.
It’s important to understand that massaging of an implant is only appropriate for smooth implants. It is not recommended to massage a textured implant, as this type of implant needs to adhere to the surrounding tissue. Since textured implants do not lend themselves to movement, they should not be massaged. I augment breasts with smooth prosthesis in my practice. By and large, most surgeries today are carried out with smooth implants, so the argument that all prostheses should be massaged is generally a good one. Prior to your surgery, be sure to discuss the specifics of your postoperative care with your surgeon. He or she will advise you on how to prevent complications through massage and other techniques.