Technique of Breast Implant Massage after Breast Augmentation to Prevent Implant Capsule Contracture or Firmness:

Capsule contracture is the most common complication resulting from breast augmentation surgery. Capsule contracture is scar tissue that results from the insertion of foreign materials into the body. Fortunately, modern techniques can help to limit scar formation.

The commonest mechanical complication of Breast Implant Augmentation is the development of a foreign body scar Capsule Contracture. There are certain techniques that I apply to greatly limit the likelihood of this problem, leading to a higher percentage of excellent results following Implant Breast Enlargement Surgery. Whenever any material is inserted into the body, be it suture, metal (such as a total joint), plastic, or silicone, the body will respond with a non-specific reaction of scar formation to try to wall off the foreign material with a scar covering. Ordinarily the body will try to limit as much as possible the size of this scar, and thus completely exclude the material into the smallest possible space. Scar formation cells have special characteristics that facilitate this normal biological behavior, but there are ways to limit the scar response by appropriate techniques both before, during, and after breast implant surgery.

First, it is very important to limit any compromise to the body's regenerative capacity. Thus it is important to maximize blood and oxygen delivery to the healing wounds by quitting smoking several weeks before the breast implant surgery.

Second, it is important to limit potential germ contamination at the time of breast augmentation surgery by adequate pre-op hygiene, including a thorough shower the morning of surgery (most soaps are germicidal, so most will do fine), Patients should also avoid shaving the armpits (for trans-axillary technique) for ten days before the morning of surgery to prevent ingrown hair abscesses in the surgical field. A strong anti- bacterial prep is done at surgery to avoid germ contamination.

Third, our plastic surgeons avoid incisions in the breast's submuscular space. That is because this area is known to harbor bacteria, which can cause scar capsule formation.

Fourth, the plastic surgeon creates create an oversized submuscular pocket, significantly larger than the breast implant size. This also helps to reduce the likelihood of capsule contracture.

Fifth, early and vigorous post-op massage of the breast implants keeps them soft, freely moveable, and looking natural. See below

Photos After Augmentation Revision Surgery:
A 35 year old is seen 3 months after release of bilateral implant capsule contractures along with size upgrade to achieve a full "D" cup at 5'4" and 120 lbs. Implants are placed in the sub-muscular position for the natural look, while avoiding wrinkling in a thin patient.	Mentor round smooth saline implants: 425cc filled to 425cc Left and 450cc Right due to asymmetry. Inframammary approach to allow internal breast lift to correct serious bottoming out of the original result
Yellow area represents the oversized implant pocket developed at the time of the breast implant placement.
Blue overlay represents the implant in the oversized pocket in the sub-muscular space.
This photo represents the technique of massage of the breast implant, displacing it out of its normal position, up into the excess pocket space above, allowing the pocket to stay widely open, and usually preventing any scar capsule contracture from forming.
The same photos showing the appearance of the breast as the implant is displaced. An animation of this process is displayed below.	Our doctors see all patients back a few days post-op to start the massage, and then every few days until mastery is demonstrated. Initially I like to move the implants every 2-3 hours, for a few days, then 2-3 times a day until about 3 weeks, and then once a day forever. The process takes a few minutes of well invested time.
Important Steps to Prevent Capsule Scar Contractures
Quit smoking pre-op Antibacterial shower and prep; no axillary shaving for 10 days Avoid cutting through breast tissue to avoid bacterial contamination Submuscular implant placement in vertically oversized pockets Start early post-op massage of implants to keep pockets open