Breast Massage After Plastic Surgery
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Manual Lymphatic Drainage Massage Before and after Explant Surgery 

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Here is some more information to help you decide whether or not to book massage before and after your breast surgery. 
 

Massage to Reduce Anxiety before Explant surgery 
 

It’s a week before your explant surgery, and you are having mixed emotions. You might be excited and ready to get your implants removed, but also scared of the pain, fearful of whether you made the right decision or not, and wondering how your results will be. You double check the supplies you have gathered after surgery and scour the posts on breast implant illness social media groups. It’s late at night and you are clicking post after post, watching video after video on YouTube. You wonder if you are ‘speeding up’ your intake of social media right when you should be slowing down and relaxing. But what else can you do about your pre-surgery anxiety? 

 

Let’s start by asking a basic question - how important is it really to control anxiety before surgery? Let’s look at its causes and potential effects. 

 

What causes this anxiety? Researchers state that “during the pre-operation period, surgical candidates experience situations that stimulate psychological anxiety leading to stress during and after surgery which is known as preoperative anxiety.” Researchers have found that the most common causes of preoperative anxiety are: 

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• waiting for surgery, 

• concern about the operation results, 

• separation from family, 

• postoperative pain anticipation, 

• loss of independence, and 

• fear of surgery and death

(Wang et al., 2022).

 

What are some risk factors for anxiety before surgery? Researchers find that “the significance of the surgery is associated with anxiety as higher levels of anxiety are reported in patients who had a greater surgical procedure. History of cancer is an important risk factor for preoperative anxiety. Previous psychiatric diseases, such as depression and anxiety may influence the extent of preoperative anxiety” (Wang et al., 2022).

 

Everyone gets a little jittery before a big event, whether it’s a vacation, a wedding or a major surgery. You may get more anxious if:

 

• The surgery is significant

• You have a history of cancer

• You have anxiety or depression

 

With explant surgery, there is an additional layer of potential anxiety. 

 

• Will the surgery help reduce your breast implant illness symptoms? 

• Will the surgeon be able to remove your capsule completely if you have decided on total capsulectomy? 

• What will your breasts look like after the surgery? 

• Will it all be worth it in the end? 

 

It’s important to know that having anxiety is COMPLETELY NORMAL. But, just because it is normal, doesn't mean you cannot do anything to reduce it. 

 

Why is reducing anxiety so important? Research shows that “severe preoperative anxiety is associated with impaired wound healing and postoperative complications like nausea, vomiting, and pain. There is a significant inverse relationship between anxiety and recovery and effectiveness of anesthesia” (Wang et al., 2022).

 

Preoperative anxiety can affect:

 

• Wound healing

• Nausea and vomiting after surgery

• Pain levels after surgery

• Effectiveness of anesthesia

 

How to reduce anxiety before surgery 

 

OK! We have taken a look at why it’s important to reduce anxiety before surgery. Now let’s look at ways to reduce anxiety including aromatherapy and massage. 

 

Aromatherapy 

 

Research has shown that “aromatherapy is used for symptom therapy of preoperative anxiety, nausea, vomiting, critical care, wellbeing, anxiety, depression, stress, insomnia, pain, dementia, and oncology in inpatient and outpatient settings.” In one study of 30 women undergoing breast surgery, “a significant reduction of preoperative anxiety was recorded after using a sustained-release lavender oil aromatherapy skin patch” (Wang et al., 2022). Aromatherapy can also be experienced through applying a topical cream/lotion and inhaling oils from a necklace or a diffuser.

 

Do you like aromatherapy and essential oils? You can share this information with your surgeon and see if using aromatherapy may be right for you. Read the full text of the aromatherapy skin patch study here: https://oregonsurgicalwellness.com/wp-content/uploads/2021/03/journal-of-perianesthesia-nursing-vol-34-iss-2-9.pdf

 

Massage 

 

Some people with breast implant illness are sensitive to scents. Massage therapy is another way to help reduce anxiety before surgery. 

 

“The role of anxiety in negatively influencing the perception of pain has been well documented and reduction of anxiety is one of the most consistent effects attributed to massage therapy across multiple studies.” (Menard, 2015). 

 

Why is massage useful before surgery? Research has found that “massage reduces pain by muscle relaxation and enkephalins release. The powerful stimulus of massage is conducted faster than pain along nerve pathways to the brain so massage can block pain conduction at the peripheral points (gaits of pain) and relieve pain. Another mechanism explains that massage can increase the circulation of soft tissue so irritant substances including lactic acid and inflammatory substances are removed from the tissue. Besides, massage reduces pain sensation by inducing a sense of wellbeing” (Wang et al., 2022).

 

What is the research about massage and anxiety levels before surgery? Several presurgical massage studies have been conducted, including: 

 

• “A randomized, controlled trial (RCT) … concluded that a 20-min massage therapy before and after operation significantly reduced anxiety” before the placement of a vascular access device (Wang et al., 2022).

 

• A 20 minute massage “for cardiovascular patients before percutaneous coronary intervention (PCI) reduced anxiety level and emergency response. Moreover, blood pressure, pain score, and heart rate after the operation were lower in comparison to the control group” (Wang et al., 2022).

 

• In another study on patients receiving a variety of procedures including cholecystectomy, hysterectomy, mass excision, and orthopedic hardware removal, “patients had one session of 30 min of massage therapy and 30 min of music listening before the operation” and the results were that “postoperative anxiety scores were lower in intervention groups compared with the control group” and “the combination of music and massage more effective than using massage or music alone in reducing postoperative anxiety” (Wang et al., 2022).

 

When should you and your care team start thinking about reducing anxiety before surgery? 

 

Importantly, researchers report that “assessment of patients about the level of preoperative anxiety 1–2 weeks prior to the surgical procedure was more effective in alleviating the anxiety compared to the preoperative visit on the night before surgery” and conclude that “earlier assessment of anxiety is recommended which provides us the opportunity of earlier intervention and referral of patients with a higher level of anxiety for a psychological consultation” (Wang et al., 2022).

 

Lymphatic massage after liposuction fat transfer to the breast and after capsulectomy explant plastic surgery 

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How can massage help after surgery? Seeing a massage therapist for manual lymphatic drainage and other types of massage after explant surgery may help you reduce anxiety, pain and swelling and improve your range of motion. 

 

Massage after liposuction and fat transfer to the breast and explant surgery

 

Dealing with swelling is a constant negative reminder of the surgery; it makes it harder to move and can feel heavy or tight. This is especially apparent if you have liposuction for fat transfer to your breasts. Swelling after liposuction is extremely discouraging for many people. They expect discomfort from the breast part of their surgery and are surprised by the swelling and discomfort from the liposuction part. To make things worse, they have an uncomfortable compression garment and now they can barely fit into their clothes! 

 

It is completely natural for your body to have swelling after surgery. In his book A Patient's Guide to Liposuction, Dr. Schafer says “swelling is caused by an accumulation of excess fluid in the treated tissue” (2001).  Swelling is normal, but if you need to get back to your normal life, there’s no reason to just wait patiently until it subsides on its own. 

 

Do you feel like your swelling after liposuction is increasing day by day in the first week after surgery? You are right. In the book Bodysculpture: Plastic Surgery of the Body for Men and Women, Dr. Engler says after liposuction, “maximum swelling and bruising—and therefore discomfort—may not occur until 1–3 days after the surgery. When bruising starts out relatively deep (as after a liposuction), it may take longer to peak, e.g., 5–10 days” (2000). 

 

In the study “Unfavourable Outcomes of Liposuction and Their Management,” published in the Indian Journal of Plastic Surgery, Dixit and Wagh (2013) reviewed the cases of over six hundred liposuction procedures and found that “swelling will be apparent within 24–48 [hours] after the procedure and continues to mildly increase for the first 10–14 days.” 

 

The Lymphatic system helps remove swelling and waste products from explant surgery

 

What can help reduce swelling? Once drains are removed and surgical incisions have closed, the body removes swelling and waste products solely through the lymphatic system. Let’s learn a little bit more about the many roles of our lymphatic system. 

 

The lymphatic system is our body’s trash and recycling system— a network of vessels that transports water, fat molecules, proteins and waste products away from the interstitial fluid around our cells. Specifically, “lymph vessels participate in the formation of lymph from the interstitial fluid and conduct lymph to the venous system” (Foldi & Foldi, 2012, 5). 

 

Researchers have also found that lymphatics help cleanse our gastrointestinal (GI) tract, stating that “the lymphatic system in the intestines mainly functions to provide homeostasis in the GI tract by filtering fluids, blood cells, and plasma proteins that enter the tissue from the blood” (Mikhael & Khan, 2023).

 

Habib et al. also suspect “altered lymphatic drainage by a foreign body impeding on the thoracic inlet may add a physical or somatic component to the disease process” of breast implant illness. They remark that “this is evidenced by conjunctival injection and changes in skin complexion, which resolve immediately the following explantation” (Habib et al., 2022).

 

Why don’t the waste products our body makes just get absorbed directly by the veins? Researchers have found that “macromolecules, cellular waste, and capillary filtrate from the interstitium are excluded from direct absorption into venous blood vessels. Instead, direct recovery of fluid lost from transcapillary filtration occurs exclusively by peripheral lymphatics” (Sevick-Muraca et al., 2023). Our blood brings nutrients to the cells, and the lymphatic system carries away the waste products. 

 

Our lymphatic system is also part of our immune system. Lymphatic fluid is filtered through the lymph nodes. Researchers found that “during transit through the peripheral lymphatics, lymph also carries antigens and antigen presenting cells to draining lymph nodes where immune activation and/or tolerance is regionally established” (Sevick-Muraca et al., 2023).

 

When tissue is damaged and vessels leading to lymph nodes are cut or damaged during surgery, short-term swelling can occur. There are several ways to reduce swelling, including:

 

• Manual Lymphatic Drainage (MLD) massage

• Exercise and joint movement 

• Diaphragmatic (belly) breathing

• External compression (the garment you wear after surgery)

 

Manual Lymphatic Drainage Massage

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Lets learn more about Manual Lymphatic Drainage (MLD). Manual Lymphatic Drainage is a gentle skin stretching massage technique that encourages swelling to move into our body’s lymphatic system. 

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How does it work? The article ‘The Utility of Lymphatic Massage in Cosmetic Procedures,’ published in the Aesthetic Surgery Journal states that “MLD utilizes gentle massaging along lymphatic channels with slow repetitive movements to reduce buildup of fluid in extremities following surgery” (Marxen et al., 2023). 

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What does MLD do in the body? According to researchers, “manual lymph drainage is a technique used to increase the lymphatic fluid transport rate, develop new routes for lymphatic drainage from congested areas to adjacent nonedematous regions, increase the activity of macrophages to breakdown protein deposits, and mechanically break up fibrotic tissue. It is indicated in patients with significant pitting edema of the extremity, trunk, or chest wall, with fibrotic or sclerotic tissue changes, and in those with significant symptoms including heaviness or tightness” (Schaverien et al., 2018). If you feel swollen, heavy or tight, try Manual Lymphatic Drainage. 

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When is MLD used? Researchers state that “there are many potential use cases for MLD in plastic surgery patients. Originally, MLD had been utilized in postmastectomy breast-cancer patients prior to undergoing reconstruction, with notable improvements in pain and swelling. Recent studies have begun to expand the use of MLD to those who have undergone cosmetic procedures” (Marxen et al., 2023).

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Which surgeries have been studied? Researchers found that “some studies have incorporated MLD in their postoperative protocol for patients undergoing breast augmentation. Additionally, multiple surgeons performing mastopexy have incorporated MLD into their postoperative protocols. There are few studies evaluating the use of MLD in reduction mammaplasty, but some studies have shown altered lymphatic drainage following breast procedures, including breast reduction, suggesting a potential benefit for the incorporation of MLD into postoperative management” (Marxen et al., 2023).

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What is the research on MLD after surgery? Researchers state that “numerous studies have found that MLD in conjunction with therapeutic adjuncts can provide reductions in edema, fibrosis, as well as provided analgesia in patients undergoing liposuction and/or lipoabdominoplasty. These been found to extended from the abdomen to all core liposuction areas, including the upper and lower abdomen, flanks, back, and hips” (Marxen et al., 2023).

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What is the research behind using Manual Lymphatic Drainage to reduce swelling? 

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This technique has a long history! People have used Manual Lymphatic Drainage to heal from Plastic Surgery for over 20 years. In the presentation “Manual Lymphatic Drainage Therapy: An Integral Component of Postoperative Care in Plastic Surgery Patients,” given at the first annual conference of the American Society of Lymphology, Dr. Casas and Dr. DePoli (1999) found that when clients recovering from surgery (liposuction of the abdomen, buttocks, hips or thighs, abdominoplasty/tummy tuck, or facelift) were treated with Manual Lymphatic Drainage massage and deep tissue massage 1–2 times per week for the first 3–6 weeks following their operation, with deep tissue massage given as subcutaneous fibrosis developed, they recovered faster. Fibrosis is the thickening or scarring of connective tissue in the body. 

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How fast is faster?

 

Casas and DePoli (1999) stated that without any postoperative decongestive therapy “we see complete resolution of postoperative edema and fibrosis in this group between 9 months to 18 months following surgery. In the ten groups listed above who underwent MLD and Deep Tissue Massage, postoperative swelling and fibrosis resolved within 6 weeks to 3 months, thereby shortening recovery significantly.”

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Why do we need MLD after surgery? 

 

When we are healthy, our bodies use movement and muscle contractions to move lymphatic fluid. Manual Lymphatic Drainage massage can help move lymphatic fluid when clients are prohibited from engaging in vigorous exercise in the first weeks after surgery. Guenter Klose, one of my teachers and an expert in the treatment of lymphedema, says “postsurgical clients who can benefit from manual lymph drainage include those recovering from cosmetic surgeries such as face-lifts, breast augmentation, and liposuction and orthopedic surgeries such as joint repair or replacement. Manual lymph drainage effectively reduces swelling even before appropriate muscle movement and function can be restored” (2014). Often, a surgeon will only allow very light exercise in the weeks after surgery. Manual Lymphatic Drainage massage can help reduce swelling before patients are allowed to use exercise and joint movement to help their lymphatic system. 

 

MLD has been found to reduce stress after breast cancer surgery. In one study, 12 participants received a 20-minute MLD session after breast cancer surgery five times per week for four weeks. Ko found that MLD is “an effective method in reducing stress and pain in patients with postoperative breast cancer” (Ko, 2021).

 

Why might MLD reduce stress and pain?

 

MLD can reduce stress in healthy subjects, which can be measured through heart rate variability (HRV). Kim et al. found that a 40-minute MLD session is “highly effective in increasing HRV and cardiac parasympathetic activity in normal subjects” (2009).

 

Why was HRV used as a measurement? Majerova et al. state that “HRV analysis is based on the determination of successive heartbeat intervals variability, which is believed to reflect the balance between the activities of the sympathetic (SNS) and parasympathetic (PNS) nervous systems, relating to the activation and regulation of stress” (2022). 

 

Other researchers have also found that MLD may have an effect on the experience of pain. Keser & Esmer measured participants' pain levels before and after a MLD session and found that “MLD increases pain threshold and pain tolerance significantly in healthy subjects.” They explained that rhythmic stimuli like MLD may create “inhibitions on the nociceptive receptors of the skin” (2019).

 

MLD may even be more effective at stress reduction than other types of massage. Shim et al. investigated the effects of abdominal MLD on the brain activity of people with psychological stress. Subjects received either abdominal massage or MLD for 20 minutes. The MLD group experienced more acute neural effects that increase relaxation than the control group, who received abdominal massage. Specifically, they found that the people who received MLD had a significantly higher average absolute alpha rhythm, significantly higher relative alpha power and a lower relative gamma power than those receiving abdominal massage (2017).

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How often should you have MLD massage after surgery? 

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Researchers state that “in the case of cosmetic plastic surgery, the postoperative period is one of the most critical phases. General postoperative manual lymphatic massage recommendations consist of manual lymphatic massage 2 to 3 times per week during the initial 3 to 4 weeks of recovery to be performed by a certified lymphedema therapist or a licensed massage therapist who have undergone some degree of lymphedema training and are often certified to perform postoperative lymphatic drainage techniques” (Marxen et al., 2023). 

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Olesen & Olesen share that their patients find Manual Lymphatic Drainage massage “not only relaxes them but also contributes significantly to their recovery” and that “some surgeons recommend one session before surgery as well as after surgery” while “other surgeons encourage only postsurgery appointments” (2005).

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The lymphatic system will keep on working hard to remove swelling as best it can for some time after the massage. Swelling leaves the body in the urine. I recommend at one or two 60 minute sessions per week for as long as swelling feels uncomfortable. Some clients only want a few weeks of treatment and others receive Manual Lymphatic Drainage regularly for a few months to achieve optimal results. 

 

My top tips for clients: 

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• Put your compression garment on as soon as possible after the MLD treatment. 

• Please drink plenty of water! Water is essential for your body. Reducing water intake will NOT reduce swelling.  

• You may urinate more (it’s how swelling leaves the body) and your urine might smell or look different.

• You may become less constipated as a result of the abdominal work that is part of your treatment.

• Manual Lymphatic Drainage is not a silver bullet or a quick fix. Your swelling will not be completely resolved in only one or two sessions. 

 

Resources:

 

Beer, K., Lupo, M. P., & Narurkar, V. A. (2011). Cosmetic Bootcamp Primer Comprehensive Aesthetic Management. Informa Healthcare. 

 

Casas, L. & DePoli, P. (1999). Manual lymphatic drainage therapy: An integral component of postoperative care in plastic surgery patients. Proceedings of The First Annual Conference of the American Society of Lymphology. 1999 Aug. Chicago. Retrieved from http://www.serenebodyworks.net/wp-content/uploads/2018/03/MLD-An-integral-Component-of-Postoperative-Care.pdf.

 

Dixit, V. V., & Wagh, M. S. (2013). Unfavourable outcomes of liposuction and their management. Indian Journal of Plastic Surgery, 46(2), 377–92. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901919.

 

Engler, A. M. (2000). Bodysculpture: Plastic surgery of the body for men and women. New York: Hudson Publishing.

Földi, E., Földi, M., (eds) (2012) Textbook of lymphology. Munich: Urban & Fischer.

Habib PM, Serena T, Derosa A. Breast Implant Illness: A Case Series. Cureus. 2022 Mar 31;14(3):e23680. doi: 10.7759/cureus.23680. PMID: 35510012; PMCID: PMC9060741. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9060741/

 

Keser I, Esmer M. Does Manual Lymphatic Drainage Have Any Effect on Pain Threshold and Tolerance of Different Body Parts? Lymphat Res Biol. 2019 Dec;17(6):651-654. doi: 10.1089/lrb.2019.0005. Epub 2019 Jul 19. PMID: 31329499. Retrieved from: https://www.researchgate.net/profile/Murat-Esmer/publication/334623092_Does_Manual_Lymphatic_Drainage_Have_Any_Effect_on_Pain_Threshold_and_Tolerance_of_Different_Body_Parts/links/5ea47f02299bf112560e6a64/Does-Manual-Lymphatic-Drainage-Have-Any-Effect-on-Pain-Threshold-and-Tolerance-of-Different-Body-Parts.pdf

 

Kim SJ, Kwon OY, Yi CH. Effects of manual lymph drainage on cardiac autonomic tone in healthy subjects. Int J Neurosci. 2009;119(8):1105-17. doi: 10.1080/00207450902834884. PMID: 19922342. Retrieved from: https://static1.squarespace.com/static/5c292c6025bf0234971b23f0/t/5d1692d29807aa0001595c05/1561760467430/MLD+and+cardiac+autonomic+tone+-+Kim+3.pdf

 

Klose, G. (2014 Oct. 1) How manual lymph drainage certification will change your massage practice. Retrieved from https://www.massagemag.com/how-manual-lymph-drainage-certification-will-change-your-massage-practice-27028.

 

Ko, M. (2021). The Effect of Manual Lymphatic Drainage on the Stress and Pain in Patient with Postoperative Breast Cancer. Physical Therapy Rehabilitation Science. Retrieved from: https://pdfs.semanticscholar.org/0a1f/308d03cfdafabb7db0ff7f4b20f32408a2f8.pdf?_gl=1*9rtovt*_ga*MTE0MjEzMzA3NS4xNjc2MjM3NzU4*_ga_H7P4ZT52H5*MTY3OTQ1OTM3NC41LjEuMTY3OTQ2MDQ3OC4wLjAuMA..

 

Majerova K, Zvarik M, Ricon-Becker I, Hanalis-Miller T, Mikolaskova I, Bella V, Mravec B, Hunakova L. Increased sympathetic modulation in breast cancer survivors determined by measurement of heart rate variability. Sci Rep. 2022 Aug 29;12(1):14666. doi: 10.1038/s41598-022-18865-7. PMID: 36038696; PMCID: PMC9424233. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9424233/

 

Marxen T, Shauly O, Goel P, Tsan T, Faria R, Gould DJ. The Utility of Lymphatic Massage in Cosmetic Procedures. Aesthet Surg J Open Forum. 2023 Feb 28;5:ojad023. doi: 10.1093/asjof/ojad023. PMID: 36998743; PMCID: PMC10045879. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10045879/

 

Menard MB. Immediate Effect of Therapeutic Massage on Pain Sensation and Unpleasantness: A Consecutive Case Series. Glob Adv Health Med. 2015 Sep;4(5):56-60. doi: 10.7453/gahmj.2015.059. Epub 2015 Sep 1. PMID: 26421235; PMCID: PMC4563896. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4563896/

 

Mikhael M, Khan YS. Anatomy, Abdomen and Pelvis: Lymphatic Drainage. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557720/

 

Olesen, R. M., & Olesen, M. B. (2005). Cosmetic surgery for dummies. Hoboken, NJ: Wiley.

 

Schafer, J. (2011). A patient's guide to liposuction. Denver, CO: Outskirts Press.

 

Schaverien MV, Moeller JA, Cleveland SD. Nonoperative Treatment of Lymphedema. Semin Plast Surg. 2018 Feb;32(1):17-21. doi: 10.1055/s-0038-1635119. Epub 2018 Apr 9. PMID: 29636649; PMCID: PMC5891656. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891656/pdf/10-1055-s-0038-1635119.pdf

 

Sevick-Muraca EM, Fife CE, Rasmussen JC. Imaging peripheral lymphatic dysfunction in chronic conditions. Front Physiol. 2023 Mar 15;14:1132097. doi: 10.3389/fphys.2023.1132097. PMID: 37007996; PMCID: PMC10050385. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10050385/

 

Shim, J., Yeun, Y., Kim, H., & Kim, S. (2017). Effects of manual lymph drainage for abdomen on the brain activity of subjects with psychological stress. Journal of Physical Therapy Science, 29, 491 - 494. Retrieved from: https://pdfs.semanticscholar.org/fe95/4e425cd9a9c6835de4eddf398953188345d2.pdf?_gl=1*5sx33s*_ga*MTE0MjEzMzA3NS4xNjc2MjM3NzU4*_ga_H7P4ZT52H5*MTY3OTQ1OTM3NC41LjEuMTY3OTQ2MTA2OS4wLjAuMA..

 

Wang R, Huang X, Wang Y, Akbari M. Non-pharmacologic Approaches in Preoperative Anxiety, a Comprehensive Review. Front Public Health. 2022 Apr 11;10:854673. doi: 10.3389/fpubh.2022.854673. PMID: 35480569; PMCID: PMC9035831. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9035831/