Singulair and capsular contracture? (Photo)

Question

Im 2 mths post and my left breast is more tender and slightly firmer then my right.. My PS prescribed me Singulair.. I was rushed through my appt and sent on my way.. Ive read up on Singulair and and worried itll do more harm than good.. anything else i could do to help? Am i massaging wrong

Martin Jugenburg, MD · Answer

Thank you for your question.

In general, capsular contracture (CC) can occur at any time,
but most cases are documented in under 12 months (i.e., anywhere from 3 months
to 12 months post operation). This is because it takes time for the fibrous
tissue capsule to form around the implant, and then it will have to scar down
(contract).

Nevertheless, CC can start early when there is significant
bleeding or infection or another co-existing problem.

Usually, the breasts will feel firm and tight this early
after breast augmentation, making you think that it may be capsular contracture.
However, such tightness is just because the breast tissue and skin have not
adapted to the implants yet. With effects of gravity and healing, the breasts
will feel more natural and soft as time goes. Once that happens, the implant
will sit directly behind the breast tissue in a natural 45:55 breast ratio.
Your breasts will achieve final results after 3 to 6 months post-surgery.

It is also not uncommon for breasts to heal and adapt to
implants at different rates.

Now I need you to know that there are 4 grades/levels of
capsular contracture:

Grade I — the breast is normally soft and appears natural in
size and shape.Grade II — the breast is a little firm, but appears normal.Grade III — the breast is firm and appears abnormal.Grade IV — the breast is hard, painful to the touch, and
appears abnormal.

If your breasts do not appear abnormal, or painful, then you
do not require surgery. In fact, grades 1 and 2 CC do not require surgery, and can
be fixed with breast massaging and singulair.

Massaging will keep the naturally occurring capsule
stretched hindering it from contracting. However, this should not be done
excessively as you may further aggravate the breast pocket causing
inflammation.

That being said, you can also help prevent a capsular
contracture by having regular follow-ups with your surgeon to make sure your
breasts are healing beautifully.

In terms of singulair, it works to prevent immune signals
leading to inflammation and there have been very few studies applying singulair
to CC, but all have shown that singulair is helpful for mild CC (i.e., less
than Baker Level 3).

In terms of side effects, you should not worry because studies
have shown that Singulair has side effects that are comparable to a placebo (a
sugar pill): headache (18.4% vs. 18.1%), influenza-like symptoms (4.2% vs
3.9%), abdominal pain (2.9% vs. 2.5%), and cough (2.7% vs 2.4%).

Below I describe information from 2 studies which have level
3 clinical evidence.

A 2010 study with 19 patients who had high risk of recurrent
capsular contracture where asked to take 10 mg Singulair for 90 days and were
also instructed to massage their breasts twice daily. 3 patients were Hispanic
and 16 were Caucasian. In the study only 1 patient had a side effect (e.g.,
fatigue). For most patients it took one to two months to experience
improvement. Out of the 19 patients, 5 had improvement in their CC, 7 had
complete improvement, and 2 were prevented from having CC. 2 patients had
worsening and 3 had no change. This means 73% had benefits and it was shown
that improvements were greater for patients with capsular contracture that was
lower than Grade 3/4.

Huang, C. K., & Handel, N. (2010). Effects of Singulair
(montelukast) treatment for capsular contracture. Aesthetic Surgery Journal
/ the American Society for Aesthetic Plastic Surgery, 30(3),
404–408.

In a 2015 study, 1 pill of Singulair (10 mg) was taken for 3
months starting on the seventh day postoperatively among 37 patients (74
breasts) out of 82 (164 breasts). From the 74 breasts in 37 patients, only 7
breasts developed Grade 2 CC. In the 45 patients (90 breasts) that did not take
Singulair, 15 breasts had Grade 2 CC, 3 breasts had Grade 3 CC, and 1 breast had Grade
4 CC.

Graf, R., Ascenço, A. S. K., Freitas, R. da S., Balbinot, P.,
Peressutti, C., Costa, D. F. B., … Kulchetscki, R. M. (2015). Prevention of
Capsular Contracture Using Leukotriene Antagonists. Plastic and
Reconstructive Surgery, 136(5), 592e–6e.

Singulair seems to be beneficial, but more studies are still
needed.

I hope this helps you decide if you want to take Singulair
or not.

Steven Wallach, MD · Answer

I have not been impressed with using Singulair for capsular contracture. I think the implant and capsule should be removed and a new pocket created with a new implant.

James Fernau, MD, FACS - Account Suspended · Answer

Thank you for your question and photographs.  I recommend you to take the advice of your surgeon, Singulair is a proven treatment for capsular contracture. If you are looking for a more natural method then I would recommend taking Vitamin E 1000IU taken twice a day. Your plastic surgeon should demonstrate proper breast massage, if you have any other questions about it you can also contact ASAPS for more information on this. I hope this helps.Best of luck in your recovery!Sincerely,

James Fernau, MD, FACSBoard Certified ENTBoard Certified Plastic SurgeryMember of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS

Singulair and capsular contracture? (Photo)

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Singulair and capsular contracture? (Photo)

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