Skip to main content

Advertisement

SpringerLink
Log in

The Effects of Zafirlukast on Capsular Contracture: Preliminary Report

  • Original Article
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Capsular contracture after breast augmentation is a distressing, troublesome event both for the patient and the surgeon. Fibrosis transforms the prosthesis into a hardened sphere, turning the initially satisfactory cosmetic result into a deformed mass. Treatment for capsular contracture can be either surgical, consisting of capsulotomy or capsulectomy with implant replacement, or pharmacologic, consisting of intracapsular instillation of steroids and antibiotics. The success rates for both types of treatment vary. Although capsular contracture is a multifactorial process, one common denominator in the successful treatment of this complication is believed to be the abatement of inflammation. Leukotriene antagonists have emerged recently as effective prophylactic agents for reactive airway diseases. Anecdotal reports have indicated that zafirlukast and montelukast effectively reverse capsular contracture. The authors investigated whether capsular contracture varies significantly over time after zafirlukast therapy by studying 20 women who had breast prostheses implanted and then experienced the development of capsular contracture. The results suggest that capsular contracture responds favorably to treatment with zafirlukast. The findings indicate that zafirlukast may reduce pain and breast capsule distortion for patients with long-standing contracture who either are not surgical candidates or do not wish to undergo surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Alfano C, Costantini M, Mazzocchi M: Clinical examination and follow-up of mammary implants. Eur Plast Surg Rew 4:4–8, 1999

    Google Scholar 

  2. Alfano C, Mazzocchi M, Scuderi N: Mammary compliance: An objective measurement of capsular contracture. Aesth Plast Surg 28:75–79, 2004

    Article  Google Scholar 

  3. Baker JL: Classification of spherical contractures. Read at the Aesthetic Breast Symposium, Scottsdale, Arizona, 1975

  4. Baker JL: Augmentation mammoplasty. In: Owsley JQ, Peterson R (eds) Symposium on aesthetic surgery of the breast. Mosby: St Louis, pp. 125–152, 1978

    Google Scholar 

  5. Baker JL Jr, Chandler ML, LeVier RR: Occurrence and activity of myofibroblasts in human capsular tissue surrounding mammary implants. Plast Reconstr Surg 68:905–911, 1981

    PubMed  Google Scholar 

  6. Becker H, Springer R: Prevention of capsular contracture. Plast Reconstr Surg 103:1766–1768, 1999

    PubMed  CAS  Google Scholar 

  7. Burkhardt BR: Comparing contracture rates: Probability theory and the unilateral contracture. Plast Reconstr Surg 74:527–529, 1984

    Article  PubMed  CAS  Google Scholar 

  8. Burkhardt BR: Prevention of capsular contracture. Plast Reconstr Surg 103:1969–1972, 1999

    Google Scholar 

  9. Burkhardt BR, Schhnur PL Tofield JJ, Dempsey PD: An objective clinical assessment of fibrosus capsular contracture. Plast Reconstr Surg 69:794–799, 1982

    PubMed  CAS  Google Scholar 

  10. Caffee HH: Capsule injection for the prevention of contracture. Plast Reconstr Surg 110:1325–1328, 2002

    Article  PubMed  Google Scholar 

  11. Caffee HH, Rotatori OS: Intracapsular injection of triamcinolone for prevention of contracture. Plast Reconstr Surg 92:1073–1077, 1993

    PubMed  CAS  Google Scholar 

  12. Camirand A, Doucet J, Harris J: Breast augmentation: Compression: A very important factor in preventing capsular contracture. Plast Reconstr Surg 104:529–538, 1999

    PubMed  CAS  Google Scholar 

  13. Clhoun WJ: Summary of clinical trials with zafirlukast. Am J Respir Crit Care Med 157:238–246, 1998

    Google Scholar 

  14. Coleman DJ, Foo IT h, Sharpe DT: Textured or smooth implants for breast augmentation? A prospective controlled trial. Br J Plast Surg 44:444–448, 1991

    Article  PubMed  CAS  Google Scholar 

  15. Collis N, Sharpe D: Recurrence of subglandular breast implant capsular contracture: Anterior versus total capsulectomy. Plast Reconstr Surg 106:792–797, 2000

    Article  PubMed  CAS  Google Scholar 

  16. Danese S, De Vitis I, Gasbarrini A: Severe liver injury associated with zafirlukast. Ann Intern Med 135:930, 2001

    PubMed  CAS  Google Scholar 

  17. Dowden RV, Reisman NR, Corney M: Going off-label with breast implants. Plast Reconstr Surg 110:323–329, 2002

    Article  PubMed  Google Scholar 

  18. Eisenmann-Klein M: Breast implants: The past, the present, the future. Eur Plast Surg Rew 3:33–43, 1999

    Google Scholar 

  19. Embrey M, Adams EE, Cunningham B, Peters W, Young VL, Carlo GL: A review of the literature on the etiology of capsular contracture and a pilot study to determine the outcome of capsular contracture interventions. Aesth Plast Surg 23:197–206, 1999

    Article  CAS  Google Scholar 

  20. Ersek RA: Firestorm fibrosis: The fast fibrotic phenomenon. Ann Plast Surg 20:494–498, 1991

    Google Scholar 

  21. Esaki M, Matsumoto T, Shotaro N, Kawasaki M, Iwai K, Hirakawa K, Tarumi K, Yao T, Iida M: GI involvement in Henoch-Schonlein purpura. Gastrointest Endosc 55:920–923, 2002

    Article  Google Scholar 

  22. Goldstein M, Anoia J, Black M: Montelukast-induced hepatitis. Ann Intern Med 140:586–587, 2004

    PubMed  Google Scholar 

  23. Gryskiewicz JM: Investigation on Accolate and Singulair for treatment of capsular contracture yields safety concerns. Aesth Surg J 23:98–102, 2003

    Article  Google Scholar 

  24. Gryskiewicz JM: What doctors aren’t being told: Using the freedom of information act. Plast Reconstr Surg 113:743–745, 2003

    Google Scholar 

  25. Hoflehner H, Pierer G: Subjective and objective assessment of capsular contracture. Eur J Plast Surg 17:69–74, 1994

    Article  Google Scholar 

  26. Hoflehner H, Pierer G, Rehak P: Mammary compliance an objective technique for measuring capsular fibrosis. Plast Reconstr Surg 80:1078–1084, 1993

    Google Scholar 

  27. Kelloway JS, Wyett RA, Adlis SA: Comparison of patients’ compliance with prescribed oral and inhaled asthma medications. Arch Intern Med 154:1349–1353, 1994

    Article  PubMed  CAS  Google Scholar 

  28. Kinoshita M, Shiraishi T, Koga T, Ayabe M, Rikimaru T, Oizumi K: Churg-Strauss syndrome after corticosteroid withdrawal in an asthmatic patient treated with pranlukast. J Allergy Clin Immunol 103:534–535, 1999

    Article  PubMed  CAS  Google Scholar 

  29. Ko CY, Ahn CY, Ko J, Chopra W, Shaw WW: Capsular synovial methaplasia as a common response to both textured and smooth implants. Plast Reconstr Surg 97:1427–1433, 1996

    PubMed  CAS  Google Scholar 

  30. Miller AS III, Tarpley SK, Willard VV, Reynolds GD: Alteration of fibrous capsule formation by the use of immunomodulation. Aesth Surg J 18:346–352, 1998

    Article  Google Scholar 

  31. Mladick RA: Prevention of capsular contracture. Plast Reconstr Surg 1032:1973–1974, 1999

    Google Scholar 

  32. Moufarrege R, Beauregard G, Bosse JP, Papillion J, Perras C: Outcome of mammary capsulotomies. Ann Plast Surg 19:62–64, 1987

    Article  PubMed  CAS  Google Scholar 

  33. Mukhopadhyay A, Stanley NN: Churg-Strauss syndrome associated with montelukast. Postgrad Med J 77:390–391, 2001

    Article  PubMed  CAS  Google Scholar 

  34. Niessen FB, Spauwen PHM: On the nature of hypotrophic scars and keloids: a review. Plast Reconstr Surg 104:1435–1458, 1999

    PubMed  CAS  Google Scholar 

  35. Oda D, Gown Am, Vande Berg JS, Stern R: The fibroblast-like nature of myofibroblast. Exp Mol Pathol 49:316–329, 1988

    Article  PubMed  CAS  Google Scholar 

  36. Perrin ER: The use of soluble steroids within inflatable breast prostheses. Plast Reconstr Surg 54:163–166, 1976

    Google Scholar 

  37. Peterson HD, Burt GB Jr: The role of steroids in prevention of circumferential capsular scaffing in augmentation mammaplasty. Plast Reconstr Surg 54:28–30, 1974

    PubMed  CAS  Google Scholar 

  38. Physicians’ Desk Reference. Accolate tablets (zafirlukast). Medical Economics: Montvale, NJ, pp 657–659, 2002

  39. Physicians’ Desk Reference. Singulair tablets and chewable tablets (montelukast sodium). Medical Economics: Montvale, NJ, pp 2181–2185, 2002

  40. Raso DS, Shlute BA: Immunolocalization of keratan sulfhate, chondroitin-4-sulphate, and chondroitin-6-sulphate in periprosthetic breast capsules exhibiting synovial metaplasia. Plast Reconstr Surg 98:78–82, 1994

    Google Scholar 

  41. Reid RR, Greve SD, Casas LA: The effect of zafirlukast on early capsular contracture in the primary augmentation patient: A pilot study. Aesth Surg J 25:26–32, 2005

    Article  CAS  Google Scholar 

  42. Reinus JF, Persky S, Burkiewicz JS, Quan D, Bass NM, Davern TJ: Severe liver injury after treatment with the leukotriene receptor antagonist zafirlukast. Ann Intern Med 133:964–968, 2000

    PubMed  CAS  Google Scholar 

  43. Rohirich RJ, Kenkel JM, Adams WP: Preventing capsular contracture in breast augmentation: In search of the Holy Grail. Plast Reconstr Surg 103:1759–1760, 1999

    Google Scholar 

  44. Schlesinger SL, Ellenbogen R, Desvigne MN, Svehlak S, Heck R: Zafirlukast (Accolate): A new treatment for capsular contracture. Aesth Surg. J 22:329–335, 2002

    Article  Google Scholar 

  45. Spear SL, Baker JL Jr: Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg 96:1119–1124, 1995

    Article  PubMed  CAS  Google Scholar 

  46. Tang WW, Van GY, Qi M: Myofibroblast and alpha 1 (III) collagen expression in experimental tubolointestinal nephritis. Kidney Int 51:926–931, 1997

    PubMed  CAS  Google Scholar 

  47. Tarpila E, Ghassemifar R, Fagrell D, Berggen A: Capsular contracture with textured versus smooth saline filled implants for breast augmentation: A prospective clinical study. Plast Reconstr Surg 99:1934–1939, 1997

    PubMed  CAS  Google Scholar 

  48. Virchow JC, Prasse A. Naya I, Summerto L, Harris A: Zafirlukast improves asthma control in patients receiving high-dose inhaled corticosteroids. Am J Respir Crit Care Med 162:578–585, 2000

    PubMed  Google Scholar 

  49. Vistnes LM, Ksander GA: Tissue response to soft silicone prosthesis: Capsule formation and other sequelae. In: Rubin LR (ed) Biomaterials in reconstructive surgery. Mosby: St. Louis, MO, pp. 516–528, 1983

    Google Scholar 

  50. Wooltorton E: Asthma drug zafirlukast (Accolate): Serious hepatic events. JAMC 170:1668, 2004

    PubMed  Google Scholar 

  51. Young VL: Guidelines and indications for breast implant capsulectomy. Plast Reconstr Surg 102:884–891, 1998

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors did not receive any financial support for this study, nor were they in any way commercially involved with the companies that manufacture the drug, the mammary compliance device, or the implants.

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, “La Sapienza” University of Rome, Rome, Italy

    Nicolò Scuderi M.D., Marco Mazzocchi M.D., PhD. & Paolo Fioramonti M.D.

  2. Department of Plastic and Reconstructive Surgery, University of Perugia, Perugia, Italy

    Giovanni Bistoni M.D.

  3. Via Portuense 331, 00149, Roma, Italy

    Marco Mazzocchi M.D., PhD.

Authors
  1. Nicolò Scuderi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Mazzocchi M.D., PhD.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paolo Fioramonti M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Bistoni M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Mazzocchi M.D., PhD..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scuderi, N., Mazzocchi, M., Fioramonti, P. et al. The Effects of Zafirlukast on Capsular Contracture: Preliminary Report. Aesth Plast Surg 30, 513–520 (2006). https://doi.org/10.1007/s00266-006-0038-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-006-0038-3

Keywords

Search

Navigation