Monday, November 16, 2009

Exercises for Breast Implant Capsule Prevention

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Implant movement or massage is often recommended to help prevent capsular contracture after breast augmentation surgery.   I try to show patients how to do this, but often it is simply easier to hand them a copy of this photo from the first referenced article below.  If they seemed to have difficultly with the exercises, I have told them to lay on a hard floor using their body weight to “flatten” the implants as an alternative method.  To view a video of implant massage go here.
As this quote from the second article below points out, it is important for the implant to be moved or massaged rather than simply the breast tissue:
Implant Movement (as Opposed to Breast Massage)
Early implant movement (within 2 days of surgery) is recommended, and aggressive movement is instituted if firmness is noticed. It is important that the patient be instructed in the proper technique of moving the implants (with full excursion throughout the pocket and pressure techniques to increase the diameter of the implant, performed three times daily), as opposed to just massage of the breast tissue, to insure maximal results.  A velcroelastic strap (Breast strap, Cosmetic Solutions, Boca Raton, Fla.) is applied to facilitate early postoperative implant positioning when needed.
From the third article below (bold emphasis is mine):
Our current approach to breast implant capsules reflects the assumption that the best nonsurgical approach to prevent capsular contracture is early postsurgical external massage. Once a capsule is established, it will most likely persist even if the implant is removed.
From the forth article:
Hipps et al reported that breast massage was not helpful; however, the exercises were begun 2 weeks postoperatively and it has been shown that the capsule begins to form by postoperative day 3…

Without doing a complete literature search, it would appear from my brief review that the issue of breast implant massage is not scientifically settled and would fall more into the “accepted practice, can’t do any harm, may help” category.  The theory is if the pocket the implant sits in is slightly larger than the implant, then the scar pocket cannot contract or squeeze the implant and cause hardness.
As pointed out at the beginning, this is a practice that I tell my patients to do.

Giving Patients a Chart Displaying Massage Techniques May Help to Reduce Capsular Contracture Rates (letter to the editor); Aesthetic Surgery Journal, Vol 22, No 5, pp 458-459, Sept 2002; Botti, Giovanni; Cella, Anonio
Prevention of Capsular Contracture; Plastic and Reconstructive Surgery, Vol 103(6):1766-1768, May 1999; Becker, Hilton; Springer, Rachelle
Treatment of Capsule Surrounding Breast Implants; Plastic and Reconstructive Surgery, Vol 115(5):1416-1417, April 15, 2005; Rockwell, W Bradford; Regenass, Heidi; Fryer, Richard
Quantitative Assessment of Breast Massage;  Plastic and  Reconstructive  Surgery, Vol  86: 355, 1990; Becker, I. I., and Prysi, M. F.
Guidelines and Indications for Breast Implant Capsulectomy; Plastic and  Reconstructive  Surgery,  Vol 102: 884, 1998; Young, V. L.

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