The Northeastern Society of Plastic Surgeons

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Breast Massage, Implant Displacement, and Prevention of Capsular Contracture After Breast Augmentation with Implants: A Review of the Literature
Erica Y. Xue, M.S., Aditya Sood, M.D., M.B.A., Christopher Sangiovanni, B.S., Edward S. Lee, M.D..
Rutgers New Jersey Medical School, Newark, NJ, USA.

BACKGROUND Capsular contracture, the most common complication following breast augmentation with implants, is a complex inflammatory reaction that ultimately leads to fibrosis at the contact site between implant and tissue. A number of peri-operative and post-operative techniques have been postulated and implemented by many to reduce the incidence of capsular contracture. Breast massage and implant displacement is a commonly recommended practice that has not been well studied in regards to capsular contracture prevention. The authors present a review of the literature addressing methods and efficacy of massage and implant displacement techniques after breast augmentation.
METHODS A literature review was performed using Pubmed and the Cochrane Collaboration Library for primary research articles on breast massage or implant displacement after breast augmentation with implants for breast contracture prevention between January 1975 and March 2017. Exclusion criteria were studies that were focused on the treatment rather than prevention of breast contracture, addressed other strategies of preventing contracture as the main focus, or did not report the number of patients studied. Information related to massage technique and capsular contracture outcomes were extracted.
RESULTS The literature search yielded 4 relevant studies with a total of 587 patients. Outcomes evaluated included massage technique, onset of massage, frequency of massage, and incidence of capsular contracture. Breast massage was introduced between two days and two weeks postoperatively, performed twice daily, and lasted from 2 to 5 minutes for each breast. Breast massage exercises were performed supine, consisted of three maneuvers or more maneuvers, and emphasized generating enough force to increase the breast pocket's surface area. Final postoperative follow up concluded between 6 to 36 months. In the massage group, the average capsular contracture rate was 31 percent and ranged from 0 to 35 percent. In the non-massage group, the average capsular contracture rate was 40 percent and ranged from 30 to 90 percent.
CONCLUSIONS While multiple techniques have been proposed and practiced in the prevention of capsular contracture, breast massage and implant displacement techniques remain controversial. Despite differences in frequency and duration of massage, there is agreement that firm pressure must be applied for maximum efficacy. A method exists to measure adequacy of breast massage pressure, though it is not widely utilized. The available data do not support breast massage as a capsular contracture prevention method; more studies with standardized techniques are needed to better assess the efficacy breast massage in preventing capsular contracture.


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