Ruben Abrams MD FACS | Aesthetic | Cosmetic Plastic Surgery | (310) 651-8881

All posts in Breast Surgeries




Many of our patients who refer for a Breast Enlargement consultation have heard or read about SHAPED ANATOMICAL IMPLANTS (ANATOMICAL FORM-STABLE IMPLANTS), formerly known as tear-drop implants and have questions as to whether they have any advantage over ROUND BREAST IMPLANTS.  In most cases the question is resolved when patients view sample photos of patients who have received standard Round Breast Implants.

Round Breast Implants Or Shaped Anatomical Implants? Which One Is Better?

Silicone Breast Implants SafetyThere is much controversy in this regard, but in our opinion, there is no advantage with Shaped Anatomical Implants over Round Breast Implants.  The shaped anatomical Implants are much more expensive and are more difficult to insert and properly position because they are textured surface implants, requiring larger incisions and only using the inframammary fold approach.  The standard round implant is available in smooth surface (our preference) and textured surface.  The smooth surface implants can be inserted through any of the available approaches, with the peri-areolar approach being our preferred one since it leaves the most inconspicuous scar.

However, there was a recent article in the Aesthetic Surgery Journal which is the official organ of the American Society for Aesthetic Plastic Surgery, in which assessors with no knowledge of the type of breast implant were asked to evaluate breasts with either Round Breast Implants or Shaped Anatomical Implants. They were asked to determine what type of implant had been used and to assess variables such as upper pole contour, natural shape and feel, etc.  Even though in this study the scores were slightly higher for the Shaped Anatomical Implants  but the difference was not statistically significant.  Meaning that for all practical purposes there is no difference between the two types of implants.


Aesthetic Surgery Journal 2015, Vol 35 (3) 273-278.




Many of our clients who refer for a breast reduction consultation come in with preconceived notions regarding the nipple/areola complex and the risk of nipple sensory loss.  A lot of these ladies are under the impression that in every case of breast reduction the patient looses feeling to the nipple/areola complex and many women have refrained from surgery for excessively heavy breasts out of this fear because feeling to the nipple is very important for them.  Still others think that feeling to the nipple is lost in “most cases”. 

So, in order to clear some of this confusion lets discuss this topic in some detail.


HOW MUCH CAN BREASTS BE REDUCED WITH BREAST REDUCTION SURGERY? imageFeeling to the nipple/areola complex is provided by the 4th intercostal nerve (the sensory nerve that travels between the 4th and 5th rib, starting from the spinal cord and coming all the way to the front).  This nerve, once it reaches the lateral border of the breast, penetrates the muscular layer over which the breast sits, and travels through the breast tissue towards the nipple/areola complex.  It is deeply seated within the breast tissue until it gets close to the nipple/areola complex, then it penetrates the breast tissue and becomes superficial, spreading within the substance of the nipple/areola complex.

So, in order to maintain sensation to the nipple/areola complex this nerve has to be preserved.  For this reason, most breast reduction techniques are based on maintaining a wide “neuro-vascular pedicle” for the nipple/areola complex, in order to preserve the vascular supply and sensation.

However, there are different techniques of breast reduction and each has its own rate of complications, including nipple sensory loss.  The most commonly used technique is the inferior pedicle Wise pattern technique.  In this technique of breast reduction, the chance of nipple sensory loss in most studies is around 5%. 

In our own series of around 1,000 breast reductions, the majority of which were done using the inferior pedicle, we have had only 2-3 nipple sensory losses, meaning a risk of only 0.3%.

Other techniques of breast reduction have a higher risk of nipple sensory loss.  For example in the superior pedicle technique the chance is around 50%, and in the Free Nipple Graft technique, the chance is 100%.  These are technique that in our practice we almost never use.




Many of our clients who refer for consultation on breast enlargement using implants come in with incorrect preconceived impressions regarding this operation.  For example many times we hear: “I don’t want my nipples to be touched because I don’t want to lose feeling to my nipples”, or “Isn’t the operation always done through the belly button?”  So in order to clear some of the confusion, here is a brief discussion on the different approaches.

Different Approaches of Breast Implants

Inframammary: “Infra” means “under” and “mammary” of course means “breasts”.  This word refers to the inframammary fold.  This is the fold under the breast.  Through a small, usually 2 inch incision, the pocket for the implant can be opened and the implant can be inserted.  This is the original technique and is probably the most commonly used till this day.  It is an excellent approach and the resulting scar is usually quite inconspicuous.  However, certain women may develop visible scars which may show when they wear a tank top or bikini.

SALINE IMPLANTS OR SILICONE GEL IMPLANTS FOR BREAST AUGMENTATION? imagePeri-areolar: “Peri” means around, and “areolar” refers to the areola.  This is what most people incorrectly refer to as “through the nipple”.  The incision in this approach is placed around the lower half of the areola.  It is a more difficult approach compared to the inframammary approach.  In our practice, however, it is the preferred approach.  The reason is that it almost always heals with invisible scars.  And even if the patient ends up with visible scars they are always hidden and only the patient and her partner know about them.  Of course there are cases where this approach is not practical due to the small size of the areola.

It needs to be clarified here that NIPPLE SENSORY LOSS has nothing to do with what approach is used because it happens when the outer part of the pocket is dissected using sharpinstruments that can injure the nerve that brings feeling to the nipple.  Therefore it can happen with any approach.  Most statistics show anywhere from 2% to 5% incidence.  In our practice we have not even seen one case of nipple sensory loss over the past 25 years with breast implants because all dissection is done bluntly.

Transaxillary: “Trans” means “through”, “axillary” means “arm pit”.  It is done through an approximately 2 inch incision that is placed in one of the axillary creases.  It is a satisfactory approach, especially for placement of implants behind the pectoralis major muscle.  There are two issues.  Although the scar usually is inconspicuous, it can still be a visible and conspicuous scar and if that happens then every time a woman raises her arm while wearing sleeveless shirts the scar will show.  Another issue is that since the incision is some distance from the pockets there is a higher chance of asymmetrical dissection and placement of implants, resulting in what patients refer to as “lopsided”.

Trans-Umbilical: This approach is the least used approach, almost abandoned.  As the name implies, if refers to placement of breast implants through the umbilicus.  The procedure is known as TUBA (TransUmbilical Breast Augmentation).  When first developed it created a lot of excitement, claiming to place breast implants with no scars on the breast!  However, since the technology is quite complex and everything is done blindly it resulted in many problems of asymmetry, misplacement, etc.  Therefore, it gradually lost its popularity.  Furthermore, the implants that were developed for this procedure are saline implants since silicone implants cannot be inserted through the tiny path that is created in this procedure.  With the comeback and increasing popularity of silicone gel implants the TUBA is on its way out.




Many women with excessively large breasts refer to us stating that they have procrastinated for years about having a breast reduction because “I’m afraid of the surgery”, “I have heard you lose feeling to the nipple”, “I don’t want my nipples to be removed”, etc.  Most of these fears are based on misinformation and preconceived notions.  But many are either afraid that their breasts will become “too small” or “remain too large”.

Breast Size

One thing that I have mentioned many times, and I need to repeat here is that cup sizes are arbitrary and do not really reflect the breast size. Cup sizes vary from one manufacturer to another.  For example what is considered a C cup at Macy‘s is a D cup at Victoria’s Secret.  This is called psychological upsizing, meaning making their customers feel good by calling their breast size a D cup while it is really a C cup by most standards.

What criteria do insurance companies use to cover breast reduction? imageSo, the size and shape of breasts after a breast reduction depends on many factors which an experienced plastic surgeon has to be mindful of.  These factors start with the patient’s height and weight.  Obviously putting B cup breasts on a lady who is 180 lbs and 6′ tall would be ridiculous.  So the final size has to be proportional to the
body.  Then comes the characteristics of the breasts, size, contour, density, etc.  For example, if a lady is an H cup and wants to be a B cup, it would probably not be possible, unless certain rare techniques are used.  Even then, usually breasts of that size are excessively wide at the base, and this will not allow reduction to a B cup.

Important Discussion Before Operation

It is very important for the patient and plastic surgeon to discuss this operation in detail, for the patient to fully understand the process, the scars, and what to expect, and for the surgeon to fully understand what the patient has in mind and whether it is realistic or not.  This is one of the most technically demanding procedures in plastic surgery and truly requires experience in order to deliver properly.  However, the most common comment we have heard from patients after this operation is “I wish I had gone smaller”.  The reason is that patients have usually gotten so used to excessively large breasts that they cannot envision themselves with small breasts and they are worried that they will end up too small.  Of course in most cases ladies ask to be made as small as possible, some even want to be “flat chest”.  But there are those who keep requesting that the doctor not make them too small, and then after surgery they wish they had asked to be made smaller.

For these reasons, the plastic surgeon not only has to be technically skilled and experienced, he / she also has to be a good psychologist and to understand what exactly is going on in the patient’s mind. 




Amongst the clients who refer for breast reduction a large number are excessively obese.  Therefore, there are several major concerns:

Is it possible to have a breast reduction when you are overweight?

In general we recommend that patients lose as much excess weight as possible and go down to as close to their ideal as possible, with an acceptable BMI.  However, in most cases of excessively heavy breasts, patients who are obese find it very difficult to lose the excess weight because the obesity and the excessively heavy breasts do not allow them to exercise adequately and lose weight.  As we have mentioned in previous blogs weight loss by the crash diets which you may have heard of is unhealthy and dangerous prior to surgery because these diets deplete the body of vital nutrients necessary for recovery after breast reduction or any type of surgery.  So this is a tough situation to deal with, and ironically it is quite common with patients who suffer from excessively heavy breasts.  The judgement has to be on a case by case basis because each individual’s circumstances are different.  However, yes it is possible to have a breast reduction when you are overweiHow to Stay in Shape After Breast Augmentation imageght if there is no other choice.

Why is it better to lose the excess weight before breast reduction?

First of all, obesity is one of the risk factors in general anesthesia, and this pertains to any surgery done under general anesthesia, not just breast reduction. By loosing the excess weight that risk factor is practically eliminated.  Secondly, obesity almost always interferes with wound healing and every experienced plastic surgeon can tell you that patients who are closer to their ideal BMI have less healing problems than those who are obese.  In other words, obese patients have a higher tendency for their suture lines to separate, open up, and result in open wounds which will take a long time to heal, or stretched and unsightly scars.  Thirdly, and this is a very important consideration, many women’s breast size changes with weight fluctuation and this is determined by their genetics.  Meaning that with weight loss their breast size drops from for example DDD to DD.  So if the breast reduction is done when the patient is at her peak weight, and then she goes on to lose weight after the surgery, the breasts will not only become smaller than intended but they will also sag.  So if the surgery is done when the patient has lost the excess weight and the breasts are the smallest they are going to be before surgery, then a proper amount of tissue is removed and the breasts are properly contoured.
Our staff are always available to help patients with nutritional guidelines and healthy eating instructions for weight management.


What criteria do insurance companies use to cover breast reduction? image

What criteria do insurance companies use to cover breast reduction? 

Until a few years ago insurance companies only required a certain minimum amount of breast tissue to be removed in order to cover breast reduction.  This amount was usually determined by placing the patient’s height and weight against a certain chart which had previously been designed by some experts in the field.  For example, for a lady who was 5’5″ and weighed 140 lbs, with DD cup breasts, the requirement was a minimum of 400 grams removed from each side, which would reduce this lady’s breasts to a C cup. 

New Guidelines for Covering Breast Reduction

The past few years has seen a significant change in insurance company guidelines and how they determine eligibility.  These guidelines differ from one company to another, and even from one policy to another within the same company.  But basically, they focus on the following:

BREAST TISSUE LOSS ImageFirst and foremost is the patient’s symptoms and how long they have been present.  Most people know that excessively heavy breasts cause symptoms such as back pain, shoulder pain, neck pain, deep bra strap grooves which are sometimes associated with skin breakdown and bleeding, rashesunder the breast which are sometimes associated with infections such as yeast infection.  Furthermore, excessively heavy breasts can cause functional kyphosis (hunching of the cervical spine) which can lead to cervical osteo-arthritis.

Most insurance companies are not interested in whether the patient has these symptoms at the time of their initial inquiry into coverage for breast reduction, but they are more interested in the history of these symptoms, meaning how long they have been present, and this has to be documented by the patient’s physician.

Next, insurance companies want to know what has been done for these symptoms, what treatments have been offered.  If the patient is primarily over-weight has any attempt at weight reduction been made?  has the patient been given medications for back/shoulder/neck pain, such as non-steroidal anti-inflammatories (e.g. Ibuprofen), has any type of physical therapy been tried, has the patient received gait-training, have the rashes required treatment with anti-fungal medication, has the patient been instructed on the use of wide-strap bras that are specifically designed for this problem.  Again, the requirement varies from one policy to another, but most policies require a minimum of 3 months of sustained treatment, and all of this has to be documented by the patient’s physician.  Sometimes insurance companies ask for records from an orthopedist stating that the patient suffers from back, shoulder, and neck pain related to excessively heavy breasts.

Once these guidelines are met, provided the patient’s policy does not have an exclusion clause for breast reduction, because some policies do, then the surgery is pre-authorized, usually with a disclaimer that “pre-authorization does not constitute a guarantee of payment.  Eligibility for payment will only be determined after services are provided and records are reviewed”.  So it is very important to diligently be aware of each company’s guidelines and requirements and meet them to the T, in order to ascertain coverage as best as possible.




It is now 25 years since the breast implant controversy began and nearly 10 years since it practically came to an end.  Despite all the information that has been provided to the public, there is still much confusion among women seeking to have breast enlargement surgery.  So lets go through the developments during the past 25 years and try to clear some of the confusion.

The original silicone implant which was developed in the 1960’s consisted of the semi-liquid type of silicone, the same type that is found in hardware stores, encased in a plastic/silicone shell.  Ever since the early days of the breast implant procedure it had become known to plastic surgeons that the body forms scar tissue around silicone implants, or any implant that is placed within the body for that matter, and that scar tissue, which is referred to as a “capsule”, can become hard and sometimes painful.  This condition is referred to as “capsular contracture“.  Manufacturers and researchers worked very hard to find ways to prevent this complication.  However, in the midst of this research some plastic surgeons developed a technique for dealing with the problem of capsular contracture in the office.  They would give the patient a stron
g pain medication and once it started working they would lay the patient on the exam table and squeeze the breast until the scar tissue broke.  This was called “Closed Capsulectomy” and was only effective temporarily.  The problem with this procedure was that in a few cases it resulted in implant rupture and the silicone was forcefully injected into the surrounding tissues, muscles of the arm, etc.  This would have consequences resulting from local reaction to silicone, i.e. silicone mastitis, silicone myositis, etc.  These are inflammatory conditions resulting from the body’s reaction to silicone.  These few cases, and other unsubstantiated problems, such as claims that silicone implants cause myalgia, lupus, connective tissue problems, etc., prompted product liability head-hunters to find ways to go after the manufacturers of silicone implants.  The details of these lawsuits and their outcome are available to the public.  Here is a link to one of the nicer sites on this topic:

IS BREAST AUGMENTATION REVERSIBLE? ImageAt any rate, the FDA banned the use of silicone implants for cosmetic augmentation and they were only allowed for reconstructive purposes pending further investigation, as if women requiring breast reconstruction are in a different category than those requesting augmentation and its okay if they run into problems with silicone implants!

However, this prompted the manufacture of saline implants for breast augmentation, a silicone shell which would be filled to the specified volume with saline on the operating table after being inserted into the pocket created under the breast. The saline implant raised several other problems.  It felt like a water balloon and did not have the natural feel of the silicone implant, it had the same rate of capsular contracture, and most importantly it leaked and lost its volume in up to 30% of cases, a phenomenon known as deflation.  This would automatically require exchange and replacement of the implant. 

Many studies were conducted both domestically and internationally, and all research came to the same conclusion: “Not a single study found any definitive evidence that silicone breast implants caused, or contributed to, any particular health condition or disease. In essence, the reports all stated that women with breast implants got sick. Women without breast implants also got sick. The percentage of implanted women who fell ill is proportionate to the general population of non-implanted women for any particular health crisis condition.”

The FDA allowed the return of silicone implants for breast augmentation in 2006, under certain conditions, one being that the silicone had to be reformulated to what is known as “Cohesive Silicone”, a specially reformulated type of silicone that is not semi-liquid, but rather semi solid, and even if the shell breaks the silicone does not seep out and remains stuck together.

So, with all this said lets answer some questions that are frequently asked by patients:

1. Isn’t it true that silicone implants increase the chance of breast cancer?

Absolutely not.  Many studies have shown absolutely no correlation between silicone implants and breast cancer.  The incidence has been the same among women with implants and those without in many large scale studies.

2. Don’t silicone implants leak and cause health problems?

No they don’t.  They cannot leak even if the shell is ruptured because the silicone is cohesive and stays within the shell.  Even if the silicone did leak, there has not been a single study that has shown any correlation between silicone and the alleged health issues.

3. Aren’t saline implants safer than silicone?

The risk of capsular contracture, which is the most common problem with implants, is the same for saline and silicone implants.  Saline implants, as mentioned above, have a high chance of deflation and loosing their volume.  So it is actually the saline implants that one has to be worried about leakage.  And once this happens it automatically means another operation to replace the implant.  So, in answer to this question, it is silicone implants that are safer because they do not have this problem.

4. We have heard that breast implants need to be exchanged every 5 years, is that true?

This is a myth which is definitely not supported by science.  Implants only have to be exchanged if they cause a problem.  For example, in the case of saline implants, if they leak and lose their volume.  Since the silicone implant does not have this problem there is no such risk for silicone implants.

finally, one reason why patients choose to have saline implants is because silicone implants seem more expensive in the beginning.  But, considering the high chance of deflation with saline implants, requiring another operation which will cost another $2000-$3000, saline implants are in reality much more expensive.




We frequently have patients who refer to us with confusion and misconception regarding sagging of the breasts, what we refer to as mammary ptosis in medical terminology.  Many of them are under the impression that the reason their breasts started sagging was because they did not exercise adequately or they did not do the right exercises.

So, lets briefly look at what the breasts consist of and why they sag.  The breasts consist of the overlying skin envelope, some fat layers under the skin, and breast tissue under the fat layers.  The breast tissue is basically modified sweat glands that have been programmed to produce milk, and of course they are connected to the nipple/areola complex via the milk ducts.  All of these tissues are connected to each other by connective tissue.  The ratio of fat to breast tissue varies from one individual to another.  Some breasts are more fatty and some are more breast tissue.  The higher the proportion of breast tissue the more dense the breast is.  Incidentally, histologically male and female breasts are identical, except that in females their hormonal changes during puberty causes the breasts to grow and a lactating hormone is produced in their body during gestation which stimulates the breasts to produce milk.

The only muscle tissue that exists in the breasts is the fine muscle fibers in the nipple/areola complex that cause the nipples to stand erect during arousal, cold weather, etc.  Otherwise the whole breast complex sits over the pectoralis major and minor muscles.

Development of sagging is primarily genetic.  We all know women who developed sagging of the breasts soon after puberty, and others who did not have any sagging at all throughout their lives.  In the absence of other factors which we will discuss in a moment, it depends on how dense vs how soft the breasts are, i.e. the proportion between breast tissue and adipose (fat) tissue, the strength of the connective tissue, and the firmness of the skin envelope.

BREAST TISSUE LOSS ImageNow lets discuss factors that affect breast sagging.

Weight Fluctuation

Weight fluctuation can result in sagging because in most women the breasts get larger with weight gain and lose size with weight loss.  Depending on this fluctuation in breast size and how the skin looses firmness each time, there will be some degree of sagging.

Pregnancy and Breast Feeding

This is the most common reason for breasts sagging.  Obviously because the breasts get engorged and increase significantly in size, and once breast feeding is over the breasts lose volume but the skin envelope usually does not regain its firmness.

Loss of Breast Volume With Age

Regardless of any other factors, most women gradually lose breast volume with age without the skin envelope firming down proportionately. Again, this is like a sac that is full, gradually being partially emptied without the sac being tightened.

So, as can be seen, exercises do not have much of a role in the breast sagging phenomenon.  Neither can sagging be prevented by exercise, nor does exercise have any role in reversing breast sagging.

What can be done to somewhat prevent sagging, well a couple of obvious things.  First of all women need to continuously support their breasts with firm bras during the day and sports bras when exercising.  The breasts should be supported adequately so they don’t jump up and down with exercise because this by itself can continuously stretch the connective tissue fibers and lead to sagging.  They also need to avoid weight fluctuation.  Finally, breast enlargement and engorgement during pregnancy is not something that women would want to suppress, because most women enjoy breast feeding.  However, there are women who are not even comfortable with breast feeding and it gives them an unpleasant feeling.  For those women it is possible to suppress breast engorgement and milk production after pregnancy by hormonal manipulation.  This can also somewhat prevent the sagging that would otherwise occur.


How to Stay in Shape After Breast Augmentation image

How to Stay in Shape After Breast Augmentation

This one really covers 3 separate areas:

1. What is breast augmentation, how is it done, and what are the indications?

2. Recovery period after breast augmentation, what you need to know: things to do and things to avoid

3. Staying in shape after breast augmentation

The first two we have covered many times in previous blogs.  So lets focus on the actual topic of the blog: How to Stay in Shape After Breast Augmentation.

Major principles after breast augmentation

There are 3 major principles that women have to follow in order to help them stay in shape after breast augmentation:

1. Healthy Eating Habits: This is something that everyone should follow.  People like to refer to this as “Healthy Diet!!”  In my opinion this is a misnomer, because “diet” is used to describe a regimen that is given to people with some form of illness or allergy, such as “Diabetic Diet“, “Hypertensive Diet“, “Celiac Diet (Gluten-Free Diet)”, etc.  So for a healthy individual, in the absence of any illnesses or allergies, healthy eating is the correct term.  In this healthy eating regimen should be included a healthy balance ofcarbohydrates, protein, and fat, along with all necessary vitamins, minerals, and trace elements.  This healthy balance is crucial for uneventful recovery and avoidance of healing problems as much as possible.  For ladies who have undergone breast augmentation it is also crucial that they maintain a sIS BREAST AUGMENTATION REVERSIBLE? Imagetable weight because in most cases the breast size has been adjusted to the individuals height and weight.  Therefore if their weight fluctuates it will result in disproportion of their breasts to their body.

2. Low Intensity Workout: This includes brisk walking which most healthcare providers agree is the best exercise soon after any type of surgical intervention.  This can be started as soon as you feel you have the energy after a breast augmentation.  As soon as your surgeon permits you can also start some upper body exercises such as elevating the arms slowly over the head or flying bird motion (at a very controlled pace) to facilitate upper body circulation and reduce post-operative edema.  Most plastic surgeons agree that during the first 6 weeks after breast augmentation lifting more than 5 lbs should not be allowed.  Plastic surgeons have different routines in getting their patients back in shape after breast augmentation.  In our practice we see patients on a weekly basis and we guide them through gradually increasing their workout until they get back to the pre-surgical level.

3. Make your workout fun and entertaining by active engagement in non-contact sports such as horse-back riding, yoga, swimming, and running.  Most plastic surgeons, including our practice, would not allow these activities until at least 6-8 weeks post-operatively depending on the patient’s recovery.  People recover at different paces and it is not possible to set exact time-tables for everyone.  This is why we see our patients on a weekly basis for the first 2 months after surgery and we monitor their recovery.  Resumption of gym exercises such as elliptical and stationary bike also is usually possible after the 6-8 week period.

Brest Implant Massage After Surgery



As everyone knows, the most common problem after breast augmentation (enlargement) with prosthetic implants is the development of capsular contracture, hard scar tissue around the implants.


Why Does Capsular Contracture Develop?

Silicone Breast Implants Safety

Whenever foreign material is placed in the body, the body forms a capsule around it, this is akin to scar tissue. This scar, just like any scar, can be anywhere from soft and pliable to rock hard. It is mainly determined by the person’s genetics.

The same way that the same cut in different persons and in different parts of the body can result in different scar characteristics, the scar tissue around breast implants varies from one individual to the other, and even from one breast to the other in the same individual.

Capsular contracture has been classified from Baker Grade I to Baker Grade 4, mainly for ease of communication. Grade I is soft and barely perceptible, Grade 4 is very hard, like a baseball. When capsular contracture is associated with pain as well some of us consider that to be Grade V.


Can Capsular Contracture be Prevented?

Unfortunately there is no way that capsular contracture can actually be prevented. There is some data regarding creating a large enough pocket, using textured surface implants, irrigating the pocket with antibiotic solution, etc. But most of this data is inconclusive and not agreed upon by all of us. At the end of the day it is the body that creates the capsule (scar tissue) and determines its softness or hardness.


Does Breast Implant massage help in preventing capsular contracture?

Scar Tissue ImageThere is really no scientific date to see if massaging the breasts actually makes a difference in the softness or hardness of the capsule around the breast implant. But nearly all plastic surgeons instruct their patients on some form of breast implant massage routine, in hopes of preventing capsular contracture, or at least keeping it at the lower grades. This is so commonly known that every patient who comes in for breast enlargement asks about it.

There are many individual variations to the breast implant massage routine. In our practice we have patients push the breasts forcefully in the upward, downward, inner, and outer direction and hold in each position for 5 minutes, twice a day. My personal experience in over 2,000 patients has shown that this routine helps.

There is ongoing research to determine the different factors responsible for capsular contracture and to come up with measures to prevent this condition. Hopefully in the future we will have better answers.