Advanced Art of Cosmetic Surgery     Thomas M. DeWire, Sr., MD, FACS    Specializing in Cosmetic Plastic Surgery     Richmond, Virginia, USA

 

 

      

        Advanced Art of Cosmetic Surgery     Thomas M. DeWire, Sr., MD, FACS    Specializing in Cosmetic Plastic Surgery     Richmond, Virginia, USA

Breast  Implant Surgery

Breast  Implant Massage After Breast Augmentation

 

Please Visit the New Version of this page on my New  Website--Dr. DeWire   

 

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

 

 

 

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  wound  healing capacity.  Thus it is important to maximize blood and oxygen  delivery  to the healing wounds by   quitting smoking  several weeks    before   surgery.      Second,   it  is  important  to  limit potential  germ  contamination   at   the   time    of   surgery  by  adequate pre-op hygiene,     including a thorough shower the morning of surgery  (most soaps are germicidal, so most will do fine),  and avoiding shaving the armpits  (for trans-axillary technique)  for ten days 'til the morning of surgery to  prevent ingrown  hair  abscesses in the surgical field.    A strong anti- bacterial  prep  is  done at  surgery  with  strict  avoidance of germ   contamination  at  the  time  of  surgery.   Third,  during surgery,   I  avoid  incision  approaches  to  the  submuscular space that necessarily cut through the breast tissues,   since they are known to harbor  bacteria  within  the  normal breast tissue ducts,  and  when  contaminants on implants,  will lead to a vigorous scar capsule formation,    causing firm capsule contracture    about     the    implants.       Fourth,    I  create  an oversized submuscular pocket,    significantly larger than the implant  size    (primarily  above  the  implant)  at  the time   of surgery to create   a  much further distance to close in before scar  can  cause  a  visible,  or palpable,   firm  scar  capsule contracture.     Fifth,  early  and  vigorous  post-op   massage of the implants,   fully displacing  them   throughout  the  entire oversized  submuscular pockets is used to keep them  wide open, and thus the implants soft, freely moveable,  soft to the touch,  and  natural-appearing  to  the  eye.   See below

 

Photos After Augmentation Revision Surgery:

Case 1:         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.

Aug-massage-ap.jpg (6697 bytes)

Aug-massage-lat-1.jpg (4776 bytes)

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  

 

  See Augmentation Revision  page  
Yellow area  represents the oversized    implant    pocket developed at the time of the breast    implant   placement. Aug-massage-ap-2.jpg (6717 bytes) Aug-massage-lat-1-2.jpg (4793 bytes)
Blue   overlay represents the  implant     in  the oversized  pocket  in  the sub-muscular   space. Aug-massage-ap-3.jpg (6754 bytes) Aug-massage-lat-1-3.jpg (4946 bytes)

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.

Aug-massage-2-3.jpg (7658 bytes) Aug-massage-lat-2-3.jpg (5633 bytes)
The  same    photos   showing the appearance of the breast as  the implant   is  displaced. An animation  of this process is   displayed    below. Aug-massage-2.jpg (7698 bytes) Aug-massage-lat-2.jpg (6583 bytes)

I see all  patients  back on the first day 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  2 weeks, then  2-3   times  a day for 2  months, then once a day forever, taking about 10 seconds of time that is well invested.

 

 Massage55.gif (117124 bytes)

 

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

 
Related  Breast Augmentation Links:   To Other photo Illustrated Procedures:

Important  Information  About  Implant  Breast  Enlargement

Trans-Axillary Breast Augmentation
Trans-Axillary Breast Incisions Scars
Breast Augmentation Shape Evolution
Breast Augmentation Shape Determination
Cleavage Determinants
Post-Op Implant Massage Technique
Implants Over versus Under the Muscle
Special Considerations in Augmentation
Breast Surgery in African American Women
Breast Augmentation FAQs
Breast Augmentation with Mastopexy or Breast Lift
Revision Surgery for Augmentation Problems
Important Information about Silicone Breast Implant Use
Nipple Reduction/Shaping
Mastopexy or Breast Lift

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Thomas M. DeWire, Sr., MD, FACS
Advanced Art of Cosmetic Surgery
3974 Springfield Road
Glen Allen, VA 23060
Richmond, Virginia, USA
804-290-0200
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ęCopyright 1997-2013  Advanced Art of Cosmetic Surgery:  Thomas M. DeWire, Sr, MD, FACS   Revised:   December 19, 2013 06:30 PM