Is Singulair safe and can it really stop the progression of capsular contracture or reverse it?

Question

I had my initial breast implant surgery four years ago and a revision with both implants exchanged two years ago. The revision was successful but now two years later my right breast feels firmer then the left. If it stays as it is I'm ok with it, I just don't want it to get worse. I Asked my surgeon about Singulair but he never prescribed it to anyone but was happy for me to try it for three months. Is it safe, what about side effects? Is it likely to help or stop a further progression of cc?

Gary Lawton, MD, FACS · Answer

I use it regularly and it is safe.  It is typically prescribed very freely for allergies.  The risk profile is low.  The effect on capsules has to be combined with massage.  It may take 6 to 9 months.Singulair may help, which can biological
soften the capsule. Sometimes in addition to the active massage of moving the
breast in the pocket (10 times per day one minute at a time), it helps to do
some passive massage.  Lie face down on a hard surface 20 minutes at a
time 3 times per day.  The weight of your body on your implants will
passively stretch out the capsule. Then you should also grab the implant from
the top, and squeeze it against the lower pole, holding steady pressure until
your hand gets tired.  Do this as often as you can in a day. This will
stretch out the lower pole.  So the combination of chemically softening
the capsule (Singulair) with the normal active massaging of the implant in
every direction (10x per day), passive massage (3x per day), and encouraging
the implant down with intermittent content pressure (as often as you can), you
should a change in the next several months.  I find no use for the bands.
If this fails, you should know by six months.  At that time a capsulectomy
would be in order.Implant massage is a critical part of
the postoperative recovery from breast augmentation (like physical therapy is a
critical part of the postoperative recovery from knee surgery).  The space
for the implant is meticulously crafted at the time of augmentation surgery,
especially when the operation is performed using the surgical endoscope through
the transaxillary approach.  However, the distance from the nipple to the
inframammary fold needs to stretch out to accommodate the implant (dropping)
and the skin and muscle need to relax to give the desired shape (fluffing).
 Implant massage allows you to manipulate the pocket from the inside to
direct the forces in the appropriate directions to mold the breast shape to the
desired outcome.  If the scar that is actively forming around the implant
is allowed to heal without the influence of breast massage, the fold will not
stretch appropriately (implant stays too high), the scar will attempt to
contract in a linear way over the curved surface of the implant (breast shape
will remain too flat), and the space will attempt to heal smaller and tighter
than the implant (capsular contracture).  Implant massage influences the
scar formation on the inside at the most critical phase of the healing,
allowing the space to be larger than the implant (mobility which creates the
natural feel and bounce).

Implant massage starts at one week at 5
times per day for one minute at a time and continues at this pace until one
month.  I often see the patients weekly during this time to reinforce the
technique and help the patients who need extra effort to soften the breasts.
During this time period, the massage also breaks up the spasm, relieving the
discomfort, particularly upon awakening from sleep (morning breast).
 During the day, every time there is the sensation of tightness, implant
massage breaks up the spasm and relieves the discomfort, minimizing the need
for narcotics.  At one month, the force that can be exerted is increased
but the frequency of massage decreases to 3 times per day.  As the wound
matures, the massage can decrease to once per day forever as maintenance.
 The patients integrate this into their shower routine.

Although some patients can get away
with no massage, it is a common issue for those who stop the massage and make
none of their follow up appointment to suddenly show up years after surgery
claiming that they woke up one morning with a capsular contracture and implant
malposition.  Of course this did not happen overnight, but was a slow
process that could have been prevented with daily maintenance massage and
regular routine follow appointments on a yearly basis (which we provide for
free, forever). With this type of perpetual follow up, it is possible to
identify a problem early that might need a modification in the massage
technique.

Implant massage involves moving the
device up against the wall of the pocket, holding pressure against the surface
of the scar. The specifics are determined on an individual basis guided by what
the patient needs. In some patients it is simple and of little significance.
 In some patients it is a struggle to get the implants into the right
position and to gain softness and mobility, but with the right technique and
the appropriate dedication it is a huge success.  For the patients that do
not participate in the massage in a meaningful way, some will get away with
their lack of dedication because they were going to have soft breasts no matter
what.  On the other hand, some patients will squander their opportunity to
have an excellent result because they don't believe that the massage is
necessary, or because they have been told by their friends or other doctors
that they didn't need to perform massage.  Regardless, they often require
surgery that could have been avoided by following the postoperative
instructions of a surgeon that has performed nearly 10,000 breast implant
operations and has seen the healing of each of those patients and integrated
the successes and failures of each one into a postoperative plan that really works.

I
find no use for bands, straps, bras or appliances after breast augmentation
surgery.

Tom J. Pousti, MD · Answer

Although it is not a good idea for online consultants to recommend specific medications, I can tell you that I use the medication frequently when I have concerns about the possibility of early breast implant encapsulation.  Your plastic surgeon will be your best resource when it comes to determining whether it may be helpful in your case. Best wishes for reversal of the possible encapsulation process.

Is Singulair safe and can it really stop the progression of capsular contracture or reverse it?

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Is Singulair safe and can it really stop the progression of capsular contracture or reverse it?

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Everything you need to know about Capsular Contracture Treatment

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