Why aren't pills that help CC given after BA instead of when someone "might be in process of getting it?

I know pills aren't proven to cure cc but it is said to help in some way although not completely proven

Doctor Answers 8

Medications that Might Treat Capsular Contracture?

The studies which suggest some medications may reduce capsular contracture are not definitive and given what we know about capsular contracture today one would not expect those medications to be very effective. The best way to avoid developing capsular contracture is to avoid the known risks factors that contribute to the development of capsular contracture (contamination of the implant surface with bacteria or foreign material, blood in the implant pocket, placement of the implant on top of the muscle, use of incisions in areas of high bacterial counts - periareolar/armpit). By taking steps to avoid these risk factors the incidence of capsular contracture can be reduced to 1% or less. 

While there is no pill to cure CC (capsule contracture), we may be able to prevent it in some cases

You are asking a very good question, and it is something that I have been thinking about too for some time.  As they say, "an ounce of prevention is worth a pound of cure!"  What if the same medications we use to treat CC after it has already started can possibly prevent it from starting?  I have actually been giving my patients 2 different medications beginning on day one after surgery.  I have been doing this for the past 2 years and observing my CC rate, and I do believe that is has helped drop that rate to around 1% or less per year.  I have had one CC that has had to return to the OR during that time.  Otherwise, we might have had a few "slightly firmer" capsules, but nothing that I or the patients would classify as Baker III capsule contracture.  This is not a proven thing, though, as there are no published studies that I know of that support this practice.  There are studies which support the use of some of these medications for treatment of established CC, though.  What we are talking about here is essentially what's called "off label use" of medications that are approved by the FDA for other things, and as doctors we can do this if we feel it is in our patients' best interest.  I happen to know that I am not the only surgeon who does this, but I do believe we are in the minority, so you will likely find most surgeons still using these medications for treatment only.  While there are things like risk of drug reactions and slightly increased cost of surgery with the additional medications, I have found neither of those things to present any kind of problem, and the trade-off for the potential reduced risk of CC has been worth it for my patients.  I wouldn't scratch my surgeon off the list just because he disagrees with this, but it is a good question to ask him just for your information.  Good luck.

Good questions

That is a really good question.  The risks for CC is relatively low.  The medications are best used when the symptoms just starts.  The problem is that CC can occur decades later.  We also don't know when you will get it.  Medications also have their own side effects. 

Best Wishes,

Nana Mizuguchi, MD

Nana N. Mizuguchi, MD, FACS
Louisville Plastic Surgeon
4.6 out of 5 stars 45 reviews

Medical treatment of capsular contracture

Although there is anecdotal evidence that some medications may be helpful in treating capsular contractures, there is very little data supporting the use of these medications prophylactically as a preventative measure. No medications are completely risk free and capsular contracture rates are relatively low using current techniques. Unless I have a particularly high risk patient, I personally do not feel comfortable pretreating  my patients unless there is some suggestion of need. 

Wayne I. Yamahata, MD
Sacramento Plastic Surgeon
4.9 out of 5 stars 40 reviews

Capsular Contracture


There are no medications that prevent or treat capsular contracture, and there is a trend towards not prescribing them at all finally, which is the right thing to do. Instead, there is an emphasis to do the surgery in a way that minimizes your risk of capsular contracture, which is very effective at prevention. Things like tissue based implant planning, avoiding a periareolar incision, covering nipples, all electrocautery surgery, triple antibiotic irrigation, and funnel delivery of the implant all help reduce your risk of this most common complication. Singulair and Accolate do not do anything. 

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

Why aren't pills that help CC given after BA instead of when someone "might be in process of getting it?

Thank you for your question. This is a very good question. There are some medications which have been postulated to treat or prevent the formation of CC. Each surgeon has a different practice preference in regards to this and no one method has been "proven" right or wrong. In my practice, I use steroids and/or Singulair as a standard postop protocol. I feel that the side effects justify the potential benefit, but some other surgeons might disagree and have a different protocol. That is what makes medicine somewhat art and somewhat science. You should discuss with your surgeon his or her preference and why.

Hope this helps!

Prevention for Capsular Contracture occurs in the surgical environment

To answer your great question, we have to know what capsular contracture is, how it is classified, and what its risk factors are.

Capsular contracture refers to tightening of the scar tissue that normally forms around the implants resulting in hardened, painful, and abnormal looking breasts with varying degrees of severity. The capsule is fibrous tissue that NATURALLY forms when anything foreign is placed in our body – this happens with heart devices as well. However, when there is too much inflammation, fluid collection, or bacterial contamination, the fibrous capsule can start to scar down further and contract.

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.

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.

Usually, the breasts will feel firm and tight early after breast augmentation, making you think that it may be capsular contracture. However, such tightness or hardness may just be because the breast tissue and skin have not adapted to the implants yet. This is why you always have to get the breasts examined by your plastic surgeon for accurate diagnosis.

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.

So now that we know capsule formation is a natural process, let me show you why the main prevention happens within the surgical environment.

The literature review by Dr. Chong & Dr. Deva titled Understanding the Etiology and Prevention of Capsular Contracture, clearly outlines what can increase and decrease the chances of capsular contracture and all things are ultimately related to implant contamination.


  • Bacterial Infection
  • Periareolar incision (natural bacteria of the breast can contaminate the implant during insertion)
  • Subglandular pocket (same reason as above)
  • Prolonged exposure of the implant to the surrounding surgical environment (lack of sterility in the surgical environment can cause contamination of the implant)
  • Hematoma (blood can increase inflammation and speed up fibrous capsule formation)
  • Use of drains (increase risk of infections by 5 folds, and thereby increase risk of CC)


  • Avoiding large implants (large implants can easily be contaminated)
  • Textured implants with submammary pocket (Textured implants may not help in the submuscular pocket)
  • Submuscular pocket (the implant is not exposed to breast’s natural bacterial flora)
  • IV antibiotics
  • Washing the implant pocket with antibacterial solution
  • Using insertion sleeves (i.e., Keller Funnel) for the implants (reduces contact with bacteria)

So medications are not really needed if the capsule is not provoked by bacterial contamination to harden and “attack” the implant.

Lastly, we surgeons are obliged to practice evidence-based medicine and cannot unnecessarily have patients go through side-effects without there being a problem. For the first 2 grades of capsular contracture – massaging and Singulair are helpful. Non-drug therapies like massaging naturally keep the capsule stretched hindering it from contracting.

Singulair 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). Now we don’t want to reduce the activity of your immune system if there is no problem to begin with. However, there is a recent study that shows that using Singulair as prevention may be beneficial.

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.

Even though singulair is found to be helpful, we need longer studies with more participants to recommend using it.

So these are all reasons why pills are not given before the capsular contracture manifests.

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.

Remember that your surgeon’s instructions should take precedence over everything else you read on here, so before doing anything, ask them.

Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 415 reviews

Breast augmentation/Breast Implants/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision

I appreciate your question.

I would recommend that you discuss this question with your surgeon as every surgeon has their own respective post op protocol for his/her patients.  Your surgeon is your best resource as he/she is most familiar with your medical history and how you are healing at this time.

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

Board Certified Plastic Surgeon


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.