Singulair for Capsular Contracture Prevention? (photo)

I had Breast Augmentation on Feb. 13 and and took 17 days off of work and have had strap for 10 days (since I went back to work). Still, the right implant is not dropping. It all feels soft and moves around just fine, but the one is quite a bit higher in my chest than the left. I have been massaging vigorously, the strap is extremely tight and has been for 4 days now (Didn't have it tight enough for the first few days).

I want to ask my doctor to prescibe Singulair, ultrasound, or possibly muscle relaxers to help the implant drop. Has anyone used Singulair in the prevention or correction of capsular contracture? Also, could CC prevent one breast from dropping/settling?

Doctor Answers (15)

Be careful of Singulair side effects

+6

Singulair is an asthma medication that was found accidently to affect capsular contracture. I used it in the past in addition to performing a complete capsulectomy and changing the implants.

It is impossible to know whether the improvement came from Singulair or the surgery or both. A randomized study would be the ideal way to study this effect. However the main issue are the side effects of the drug, mainly liver problems.

A capsule will prevent drooping but if too tight, it could distort the breast. I hope that helps.


Orange County Plastic Surgeon
5.0 out of 5 stars 6 reviews

No science behind pills for capsular contracture

+6

Dear Kittcarzy, I saw your photos on the site yesterday. I know you are concerned about the right side being higher than the left. This can be from many causes, one of which is capsular contracture. As I recall, you have saline implants and these rarely cause cc. Again, please sick close to your doctor and their advice, keep up with massage, perhaps wear an upper pole strap and be patient. You won't know the final outcome for 3-4 months after surgery.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 48 reviews

Singulair and Accolate therapy for capsular contracture

+4

Singulair is a drug which comes from the class of leukotriene recptor antagonists. The use of Singulair for capsular contracture is based on anecdotal reports of improvement (softening) of capsular contracture in individuals undergoing treatment with Accolate, another drug in this class. Accolate is prescribed twice a day. The advantage of Singulair is its once-a-day dosing and relatively high safety profile. It is one of the most popular pediatric asthma medications.

The initial reports coming from Hawaii claimed that it was most beneficial if patients were treated within 6 monhts of surgery.

There is some logic in the use of these meds becasuse they block the inflammatory effects and constriction effects of leukotrienes in asthmatic individuals. The obvious thought was that maybe they could minimize the bodies' inflammatory responses and contraction of tissues surrounding breast implants. However, true data and studies validating their use are lacking. Although generally safe, they do require monitoring and occasional blood work.

I have had patient's treated with both this and Accolate. Although some physicians report as hgih as an 80% response rate, I would place my response rate at 50%. Therefore, I am not an enthusiatic proponent of this therapy.

To answer your second question: Yes, it is likely that the capsular contracture is "holding up" your implant and preventing it from descending. It is still relatively early after your surgery and you should perform preferential breast implant displacement exercises if cleared by your plastic surgeon.

I hope this helps to explain.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

No to Singulair for Capsular Contracture

+4

The reports of the success of Singulair in treating capsular contracture is anecdotal, meaning there are no large studies confirming it's effect. This is off label use of the medication. This drug is associated with severe side effects including liver failure that is not worth the risk for an unknown benefit.

Michael S. Beckenstein, MD
Birmingham Plastic Surgeon
5.0 out of 5 stars 10 reviews

Anecdotes aren't yet proven

+4

Kiltcrazy,
There are anecdotes regarding the use of Singulair and other antiinflammatory asthma medications to decrease capsular contracture. The effect has never been proven. Remember, everything we do has consequences, including prescribing a seemingly harmless medication.

Kenneth R. Francis, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 31 reviews

Don't take Singulair for capsule prevention

+4

It would be nice to think that a pill such as Singulair would be effective in preventing capsule contracture however there is no evidence that the medication is effective and is considered an "off label" treatment. The side effects of the medication are impressive and patients receiving the medication need close medical followup and periodic testing. You would want the medication to be of proven effectiveness to make the treatment and potential risks worth the effort.

It appears from your question that one implant failed to drop, or was always slightly higher on one side. If you are still in the first few weeks after your breast augmentation the implant may respond to a band or wrap across the upper breast to hold the implant down in the pocket with firm massage on the tight or high side as well. If massage fails the pocket may need to revised to position the implant lower and centered within the breast.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 28 reviews

Singulair for Capsular Contracture is Off Label Usage

+3

 I suspect you are right hand dominant and you simply have more tone in your right breast and your implant will drop in time just a bit slower than the left.You are not a candidate for Singulair usage at this point. Keep up the massage, breast strap, and if you want ultrasound.

Singulair is used as a FDA off label usage to treat Capsular Contracture and in some cases of recurrence of capsular contracture in a preventative fashion. This does not apply to you for the following reason:  Although capsular contractures following breast augmentation  can occur just about anytime, most women start having symptoms around three months after their breast implant surgery. This is because it takes some time for a capsule to form and then to scar down (contracture). Therefore it is probably too early at 3 weeks to be concerned about this problem. Your signs and symptoms are most likely from muscle spasm although other factors could also cause this. Your plastic surgeon should be able to sort this our in short order.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 45 reviews

Doesn't sound like capsular contracture

+3

I have looked at your photo and read your history and it looks like you have some asymmetry of settling in the pockets. You are doing the right thing to massage and encourage the right implant to go down. This is probably due to the muscle on the right side being larger and stronger.
Continue to massage and work the implant pocket. I would recommend this treatment for the first three months and then if it is still too high but loose in the pocket you will need an open capsulotomy.
Singulair is not the answer.

Marcus L. Peterson, MD
Saint George Plastic Surgeon
4.0 out of 5 stars 14 reviews

Implant dropping

+2

It sound like your one side just didnt drop as it was supposed to after surgery.  This may be that the pocket just is not large enough, or that you have some early contracture.  At this point, I would be massaging the breast as much as possible.  The strap may help, but I do not think it will force the issue if the pocket is too tight already. 

At the three month mark, that is when you reassess things and see what may need to be done.  Singulair may work for some people, but the data is anecdotal and we have no way to know whether it truly works or not.The same thing goes for external ultrasound.  They may help some women, but you have no way to know.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.5 out of 5 stars 22 reviews

Singulair and capsular contracture

+2

First of all, it sounds like your breasts are dropping normally. At only 2 1/2 weels it is a bit early, and it may take a few months to really settle in. As for singulair, there are no strong scientific studies supporting its use.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.