Singulair and Capsular Contracture? (Photo)

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

Doctor Answers 4

Singulair for Mild Capsular Contracture

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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:
  1. Grade I — the breast is normally soft and appears natural in size and shape.
  2. Grade II — the breast is a little firm, but appears normal.
  3. Grade III — the breast is firm and appears abnormal.
  4. 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.


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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!

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS

Singulair and capsular contracture

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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.

Breast Augmentation - Singulair ok for capsular contracture

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Thank you for asking about your breast augmentation.
  • Capsular contractures usually don't appear this early -
  • Has the left breast always been more tender and firmer or is this a recent change?
  • Singulair does soften capsular contractures -
  • It is an allery/asthma drug which inhibits leukotrienes, which promote inflammation.
  • However it does have a range of risks - stomach pain, skin rashes, tremors.
  • And recently, a worry that it increases depression and suidide.
  • You do not have to take it if you are concerned - or you can try it and stop if if you run into problems.
  • But it is so far the only non-surgical treatment we have for capsular contracture which is an inflammatory response (with a range of causes) to breast implants.
  • Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

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.