Capsular contracture is one of the big issues of breast augmentation. If you hear of a patient who says, “my breast implant turned hard,” it is NOT the implant that turned hard. It is the capsule. The capsule is a layer of scar your body forms around a foreign object (in this case the foreign object is the breast implant.)
Enter leukotriene inhibitors.
The brand names for these are Singulair (montelukast) or Accolate (zafirlukast). The use of these for capsular contracture was talked about starting in 2002. It was mostly anecdotal, though since then multiple studies have shown benefits.
This study was done by one of my fellow residents from Stanford (whoop! whoop!) where he published “Prophylactic Leukotriene Inhibitor Therapy for the Reduction of capsular Contracture in Primary Silicone Breast Augmentation: Experience with over 1100 Cases.”
- Three arms: no rx, Singulair rx, or Accolate rx
- All had smooth silicone implants place through periareolar (72%) or IMF incision (28%)
- They had preop antibiotics, triple antibiotic irrigation, and iodine irrigation, nipple shield, implant glove change, dual plane insertion. (Keller funnel- I’m unsure if he uses)
- Singulair dose was 10mg/day, Accolate was 20mg twice a day. This was done for 3 months after surgery.
Findings?
- He looked at capsular contracture rates at 1 year.
- Patients discontinued Singulair 2.5% or Accolate 6.2% because of minor side effects or cost
- Only 3 of 528 patients on Accolate had elevate liver function tests and had to stop.
- There were higher rates of capsular contracture with the periareolar approach (*this has been seen in other studies. See my blogs)
- At 1 year, those on both medications had lower capsular contracture rates, with Singulair having an encapsulation rate of 3.27% and Accolate having a rate of 2.19%. (no treatment rate was 5.02%)
He concludes Accolate is better than Singulair.
My thoughts?
Regarding Accolate vs. Singulair–Interesting. Accolate requires 2x/day dosing. I don’t know the cost or side effects. It also has the requirement of checking liver function tests, with the cost also of that test. I give Singulair to all my patients and don’t have problems with it.
I’m on the fence with this one. But good to see options.
Regarding the other data in this– It supports the IMF incision to avoid capsular contracture. He does everything against biofilm impeccably.