Displacement exercises of the freshly implanted augmented breast was the mainstay therapy in the prevention of capsular contracture (CC). Started in the 1970s this therapy was widely proscribed and every augmentation patient was instructed to push her implants medial and lateral as well as up and down and finally to squeeze the new breast firmly. New research in CC and the effectiveness of implant massage have thrown serious doubt on this recommendation. Below are my top five reasons why I no longer recommend massage.
Careful studies have shown that massage is ineffective in the prevention of CC. Many surgeons continue to recommend massage believing that “it may help but it does no harm” We now believe that massage is harmful.
CC is directly related to the development of a biofilm around the implant. Biofilm is the invasion of microorganisms into the surface of the implant. The source of these microbes is believed to be from the native breast flora. Massage may squeeze these microbes from the breast tissue to the fresh implant. Early massage may make CC more likely. Prevention of biofilm is in intravenous antibiotics fully infused prior to the patient taken to the OR.
Aggressive early massage may be a cause for implant mal-position and cause ‘bottoming out” and “double bubble” deformities as the native IMF ligaments are destroyed. Stretching of the lateral ligaments in a sub muscular augmentation results of on overly large lateral pocket allowing the implants to slide in the armpit especially in the recumbent position. Finally pushing the implants aggressively to the midline may result in the sternal skin to be lifted and result in synmastia (aka unaboob). We now believe that aggressive massaging is harmful.
There are better and effective methods to prevent CC and this should be emphasized over ineffective massage. Early intravenous antibiotics that are completely infused in the holding area prior to entering the OR, pocket irrigation and techniques that separate the breast tissue from the implants are effective methods in CC prevention.
Early massage in a fresh augmentation especially when there is a concurrent mastopexy-lift is painful. Pain results in elevated blood pressure (with can cause a hematoma), reliance on higher narcotics use, and chronic hypersensitivity.
There are good reasons not to recommend the traditional massage and displacement methods anymore. Why do some surgeons still teach this? Perhaps they are not current on the research, or it gives them a reason to shift blame to the patients if a capsule forms. What is your defense against CC? We recommend that the modern surgical techniques are followed and that you use a top of the line implant made by Mentor in the US that comes with an excellent protection plan that shields you from excessive cost in case you do develop a CC.
For more information on any services or to schedule a consultation call 361-993-2222