Breast Implant Exercises

Michael A. Bogdan, M.D., F.A.C.S.

Breast implant exercises are aimed at helping you achieve natural appearing breasts and also to maintain soft breasts. These videos depict how Dr. Bogdan requests his patients perform the exercises. They are animated with graphic overlays of the implant to help understand the goal of the individual exercise. These exercises are very specific, and are applicable for smooth, submuscular breast implants (saline or silicone). The exercises are not appropriate for every patient, so only perform the exercises that Dr. Bogdan has instructed you to do.

Immediately after breast augmentation surgery with submuscular placement of the implants, the breast implants are sitting in a surgically created space partially under the pectoralis muscle and the lower portion of the breast. Your body will quickly begin to form a scar capsule around the implant, and we would like to modify the shape of this capsule as it is forming. With smooth implants, Dr. Bogdan wants to achieve a large space in which the implant can move. This has the effect of making the implant feel softer (it has some place to move when you are touching / compressing the breast), and it makes the breasts appear more natural. Additionally, these breast exercises keep the capsule wide and soft, and thus combat capsular contracture (hardening of the breast capsule).

Bandeau use for post operative positioning of breast implants
During surgery, a new space is created inside the breast "envelope" which is partially covered by the pectoralis muscle and the lower portion of the breast. The location and dimensions of this pocket are finalized while the patient is in the sitting position on the operating table, so that the final appearance of the breast is visible. The inframammary fold incision is the approach most often utilized by Dr. Bogdan. Because the "ideal" implant position places significant pull on this incision, Dr. Bogdan allows the implants to "relax" on the first post operative day in order to let the incision start to heal under more ideal conditions with less tension. Since the pectoralis muscle has resting tone and is effectively elastic, the natural position for the implant to sit is half way between the clavicles and the inframammary fold. This will make the implants appear to "ride high" during your first post operative visit. This effect is more pronounced with larger implant sizes and more youthful breasts. (Women who have had children already have "pre stretched" breast envelopes, so the breast is more accepting of the implant.)

The Bandeau is an elastic strap that can add external tension onto the implant, and assist with achieving the desired position. The ideal stretching force is straight down, but this is not possible with the geometry of strap placement. The strap should be placed as high as possible on the chest (near the clavicles) with the posterior portion at the level of a normal bra strap. In this position, the front portion of the strap is above the implant, and as it slides down it will have the tendency of pushing the implant ahead of it. Patients frequently place the front part of the strap too low, such that it is over the implant. This position is more uncomfortable, and is not as efficient at helping the implant drop. The strap should be snug, but not overly tight! It is important to add some padding (a small athletic sock works well) between the edge of the strap and the arm pit to reduce chafing. (If this area gets irritated, you will not be able to tolerate wearing the strap.)

Medial implant exercises to enhance cleavage
The first exercise that you will start performing is the medial displacement of the implant. This can be started the first day after surgery. With submusclar implants, the cleavage achieved with the implants is dictated by the width of your breast bone (sternum) and the origin of the pectoralis muscles. The muscle and blood vessels that supply the muscle come off your chest right at the junction of the breast bone and the ribs. As such, you do not want to try to push the implant past this point, but rather stretch the envelope wall along this region so the implant can easily reach the medial position. (If the peri-implant capsule is soft in this region, you can easily achieve significant cleavage with a minimally supportive bra.) The exercise is performed by crossing your hands to either side of the chest, cupping the outside of the breasts, and gently compressing towards the center. The implants will move towards each other, stretching the medial portion of the capsule. Dr. Bogdan requests that you perform the exercises twice per day, holding the stretch position for two seconds, and completing five cycles. (Please note - this exercise is for submuscular implants! If you perform this therapy with subglandular implants, there is a real possibility of pushing the implants across the midline and creating symmastia [uni-boob]. Please only perform this exercise if you are instructed to do so by Dr. Bogdan.)

Upward breast implant exercise to combat capsular contracture
After your implants have dropped into their ideal position, it is important to maintain a large potential space for the implant to move within. If you manage to keep the peri implant capsule wider than the actual implant, the implant will have someplace to easily move, and this will make the breast feel soft and act natural with positional changes. Gravity is always working on pulling the implants downward, and your pectoralis muscle works to push the implants down and to the side. It is important to continue the medial implant exerecises, and to incorporate the upward exercises to maintain the space above the implant. This is performed by displacing the implant upward while teathering the capsule downward. Since the capsule is closly related to the skin, externally you can hold the capsule in place by holding your skin in one position. The exercise is performed by placing your hand at the level of the inframammary fold (similar to a Karate-chop). While maintaining the position of the small finger at the same level of the chest, rotate down the palm and compress the lower portion of your breast. The implant will move away from this compression similar to how dough moves away from a rolling-pin. You should see fullness in the upper portion of the breast, and feel some tightness. Just as the medial implant exercise, perform this twice daily, 5 times each, and hold the position for 2 seconds.

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