How long does it usually take for someone to see results from accolate, vitamin E, and massage? Level II Capsular Contracture.

Question

I was dx'd with level II CC on my left breast and I have been taking accolate, vitamin E, and massaging. It softens up A LOT when I get home heat pack and massage (in the morning it is also soft, it gets tighter at work since my job can be physical) I was wondering how long it typically takes for accolate to take effect and how long people stay on it. I have silicone implants. Once they are no longer on the medication does CC typically restart? Can it occurr again randomly?

Gerald Minniti, MD, FACS · Answer

Hello,I'd like to mention a few things specifically regarding your treatment as well as some general information.  As lovely and symmetrical your results appear, these implants are vastly too large for your chest wall and soft tissue envelope, and issues with capsule formation are common in this situation.  You don't mention how long it's been since surgery, but it is also common for one implant to feel firmer than the other for weeks to months.Implant massage is not necessarily harmful, but I can tell you that it has no effect in the prevention or treatment of capsular contracture.  This has been established through clinical science, yet many plastic surgeons continue to recommend it to their patients - it's what they were taught by their professors and mentors years prior.  One large study published in the PRS journal in Nov 2012 following 100 top breast surgeons looking at their outcomes found that those surgeons that recommended massage had a HIGHER rate of capsular contracture than those that didn't.  Although the statistical significance of this finding is perhaps weak, I can assure you that your massaging will have no effect on your ultimate outcome and these transient periods of softening - probably muscular relaxation - do not indicate you are doing anything of long term value. More concerning to me is your use of Accolate. Leukotriene inhibitors like Singulair and Accolate have been studied multiple times, and their efficacy remains borderline to non-significant.  On the other hand, there is a real risk to liver injury with Accolate, and blood tests to monitor liver enzyme levels should be performed regularly. Because the risk to benefit ratio of Accolate is poor, the American Society of Plastic Surgeons came out with a statement many years ago recommending to its members not to prescribe it to their patients.  My personal experience with them, which correlates well with my colleagues here in LA, is that it seemed random at best, and no more than a small percentage responded.  My strong recommendation is to stop the Accolate and if you insist, have your surgeon put you on Singulair.Vitamin E has a similar efficacy profile; it works on occasion in some individuals.  Although there is no apparent harm in taking high doses, it should not continue for more than a few months.  General recommendations for vitamin E is now no more than 200 i.u. per day on a long term basis.  This has something to do with information gleaned from an Alzheimer's study looking at elderly people, that found that those taking high doses of vitamin E had higher rates of heart attacks and strokes.  This was significant enough to stop the study. In general, capsular contracture is more likely to be a temporary phenomenon in it's lowest grade, which is what you are experiencing.  My recommendation would be to relax and enjoy life.  For future prevention though, I recommend prophylaxis with antibiotics, one dose prior to 'dirty procedures' like teeth cleaning/dental work or any gyn procedures.  This should prevent late term capsular contracture by preventing bacterial invasion into your bloodstream that could ultimately seed your implants.Best of luck!

Michelle Spring, MD, FACS · Answer

You didn't mention how long after surgery your capsular contracture showed up?  Accolate or another drug, Singulair, - as well as vitamin E - are sometimes used to treat capsular contracture.  Anecdotal evidence has shown that they may help reverse the process or halt it.    These are off-label (FDA) uses of the medications, and while there is no specific proof that they work, I have seen improvement in capsular contracture by doing the things you wrote about.    I usually have patients try these methods for 3 months or so.  If there is no stabilization or improvement, I don't like to keep patients on the medications indefinitely due to potential side effects.     Capsular contracture can recur in the future or once medication is stopped, but there is no way to predict exactly what is going to happen.   Many women have grade II capsular contracture that never progresses and doesn't bother them.   Best wishes,Dr. Michelle Spring

Ryan Neinstein, MD, FRCSC · Answer

If all that stuff is going to work which I really believe it does in 50% of people as the study shows it will take about 3 months

Megan Jack, MD · Answer

It may take several months for you to consistently feel/see a difference.  I would suggest consistently massaging your implants several times each day to ensure the pocket stays open and soft.  I typically also suggest to all of my implant patients that they spend some time laying on their belly to put some pressure on the implants. One other option for you would be to do a little research in your area to see if anyone near you performs ASPEN. This is a technique that is becoming more popular post-augmentation/reconstruction to help achieve a softer implant and better symmetry through a combination of massage, ultrasound, and special bandaging.  It has VERY promising results although technically it is off label use as they are still going through the FDA process from what I understand.

How long does it usually take for someone to see results from accolate, vitamin E, and massage? Level II Capsular Contracture.

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Answer: Management of capsular contracture after breast augmentation

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How long does it usually take for someone to see results from accolate, vitamin E, and massage? Level II Capsular Contracture.

Answers (4)

Answer: Management of capsular contracture after breast augmentation

Answer: Management of capsular contracture after breast augmentation

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Everything you need to know about Capsular Contracture Treatment

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