Will the medication help me? (photos)

I got my BA 5/1/2014 but I developed a CC on my right breast. I had to undergo surgery once more on 4/9/2015 & the same is happening again. I am growing frustrated. I just recently started taking Singulair on 9/7/15 and I have been massaging aggressively. How long do I have to wait to feel softening on the right breast. I am now 5 months p/o.

Doctor Answers 10

Will this medication help me?

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I appreciate your question.
I do not recommend this medication.  Speak to your Plastic Surgeon about doing a removal/replacement of implants with capsulectomy.  Inquire about using acellular dermal matrix.

The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative plastic surgery.

best of luck!

Dr Schwartz

Capsular contracture after breast implants

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Thanks for posting your question. I am happy to try and help you. It is important to remember that a board certified plastic surgeon will be your best resource when it comes to an accurate assessment of your situation, and concerns.

Having said that, capsular contracture is a very unfortunate condition that may develop after breast augmentation surgery. The cause is an enigma and we have some suspicions that it may be caused by subclinical bacterial infection, or excessive bleeding during or after surgery. The treatment is also complicated and some PS will through the kitchen sink at it trying to make it go away. Some times it works, other times it does not. Ultrasound, asthma medications (singular), reoperating, scar tissue removal, changing to a different breast pocket and even implant removal have been suggested to treat it. The other problem is that it may go away after all of these heroic efforts only to have it return. In other cases, one of these may work and it does not come back. It is a tough problem.

I hope you found this helpful. Have a great day.

Will the medication help me?

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Hi, md1015.  Sorry to hear about your recurrent capsular contracture.  I do not think Singulair or massaging would help at this time. When you undergo implant exchange with capsulectomy, consider 410 textured implants with/without dermal matrix.  Please discuss your options with your plastic surgeon.

Treating capsular contractures

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are challenging and if you're willing to find an ASPEN ultrasound provided in your area, you can see what kinds of programs they have for you as they claim their technology can help.  But before you plunk your dollars down, you should know what happens if there is no benefit from their technology.  If they cannot provide you some consumer protection (a full guarantee is unwarranted as they are doing a service) if they truly know their technology works.  As for the medications, anecdotal evidence is what fuels the use of them.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

The difficulty of capsular contracture and the art of plastic surgery

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Be patient, do the breast massage. 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. Lay 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 constant pressure (as often as you can), you should hope for a change in the next several months. I find no use for the bands. For the surgeons that talk only of science, they have lost the art.  There are things we don't know about capsular contracture.  One must try every trick in the book.  Experience helps.  Whatever works for your plastic surgeon is what you should try.  Capsular contracture does not have one answer.  If it did,  it wouldn't be such a challenging problem. It is not false hope if it works.  Anecdotal evidence is all you need if you can get it to work sometimes.  Everyone knows about en bloc capsulectomy.  Unfortunately, that treatment alone is not associated with a 100% success rate.  If your surgeon is not willing to try everything that has had some success, they are cheating you out of a chance for resolution. Believe me, I am a firm believer in science.  However, I am also smart enough to know that we do not know everything.  Are you willing to say that acupuncture and acupressure have no value because there is no Western scientific proof?  Would you have been among the non-believers before antibiotics had sound scientific proof?  What does the future hold?  How long has ADM been around?  Ask the experts who tell you that it is the solution to your problem how much data there is to support this product, and if they had all the answers 10 years ago and would have suggested ADM then.  Try everything you can under the direction of your open minded surgeon. Realistically, you may have more surgery in your future.  But don't give up hope today for a surgery that may or may not be needed in 3 months. By the way, en bloc excision through the nipple areolar complex is an excellent alternative to the inframmary approach, which is technically limiting in terms of exposure. This is a difficult problem.  Try to avoid surgeons that claim to know the answers to every question.  

The best treatment for CC

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I'm sorry about your predicament. Singulair and Accolate are not effective. Neither is implant massage. The data doesn't support either, and it's about time that we acknowledge this and not give false hope to our patients, which unfortunately is very common and widespread. 

If you're interested in effectively treating this problem, I suggest finding a revision specialist who can provide you with better help.  The most important thing that can be done is the right operation,  and a total capsulectomy en bloc (in one piece) through an inframammary incision is the best, most effective way of removing all the offending scar without re-contaminating the pocket. This is crucial to prevention of recurrence. 

Once the the scar is out, a new implant should be replaced via an implant delivery funnel to prevent contaminating it during entry. Finally, consideration should be made for using an ADM like Strattice. An argument for using it would be that this is going to be your third operation. An argument against is that your implants are relatively small, and much of the implant is actually subpectoral.  I would probably not use it. 

Best at of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Singulair for CC

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The best data for Singulair indicates usage for 90 days.  Massage hasn't been shown to do much, so I'd just recommend to continue with the Singulair and give it time.  If you have to undergo surgery again, I think the best combination of techniques to prevent recurrence is total capsulectomy, irrigation with a dilute bleach and steroid solution, placement of a textured implant into a sub-pectoral pocket, use of a drain, possible use of Alloderm, and beginning Singulair the day of surgery and continuing for 90 days.  I wish you best of luck with preventing CC.

Kyle Song, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 40 reviews

Singulair for capsular contracture

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The use of Singulair is off-label for cap contracture. Results are mixed because the causes of capsular contracture are multifactorial. There are also different capsular contracture rates depending on the implant material (silicone vs. saline) and coverage (textured vs. smooth). The 3 major implant companies now offer capsular contracture coverage but for primary augmentations only and for augmentations performed after October 2014. Considerations for revision capsular contracture surgery should be discussed with your plastic surgeon based on the operative plan of the first 2 surgeries. 

Tom S. Liu, MD, MBA
Los Gatos Plastic Surgeon
5.0 out of 5 stars 3 reviews

Will the medication help me?

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The medication is used off label.  Many plastic surgeons feel that it helps with capsular contractures, but that is not proven.  You may be a candidate for AlloDerm Tissue Matrix such as Strattice.  This has helped the rare patient that continues to develop capsular contracture.  Discuss your options with your Plastic Surgeon.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Capsular Contracture

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The data is mixed on the effectiveness of medication and capsular contracture.  My protocol for treatment is a capsulectomy, submuscular implant pocket, textured implant, and wash pocket with steroid solution prior to replacing with a textured implant.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 59 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.