Post-operative breast implant massage: Does it help?

A frequent question we get about breast augmentation is whether or not post-op massage is recommended or potentially beneficial. One popular website, BreastImplants411.com, has created a checklist including a question about implant massage; patients considering breast augmentation are supposed to ask specifically about it. And plastic surgeons seem to be split on the question, with some strenuously advising it and others cast as non-believers. With such contradictory views, what is an informed person supposed to make of it?
The main idea behind it originated in an era when capsular contracture, a hardening of the scar capsule around the implant, was much more common. Plastic surgeons were trying anything that might make a difference, and cases of contracture were sometimes treated with a fairly brutal procedure called a “closed capsulotomy” which consisted of squeezing the breast hard enough to make the scar capsule rupture. Although patients might run out of the clinic in tears, the breast would be softer (for a while.) So the thinking was that perhaps squeezing the breasts on a regular basis, especially during the healing period, could prevent the scar from contracting in the first place.
In retrospect, it was a fairly naive notion, but there wasn’t much else to offer because the causes of capsular contracture were so poorly understood at that time. So it became entrenched as a routine practice and no one bothered to do a clinical study to see whether it did any good. In fact, to this day no such study has been published. Evidence now points to bacterial biofilms, invisible contaminants caused by miniscule numbers of otherwise harmless germs, that cause a reaction in the scar that encloses the implant. Better surgical techniques and better implants than the ones used 25 years ago appear to be the important variables.

So at this point we still have no objective evidence that post-op implant massage makes any difference in capsular contracture. There are certainly cases where swelling tends to push implants up and massage can be helpful in getting them to settle, but that is only sometimes the case. So the question shouldn’t be “Do you recommend massage?” but if so, “Why?”