Singulair and Capsular Contracture

In this month’s issue of the Aesthetic Surgery Journal is a nice little retrospective study looking at the effect of Singulair on capsular contracture. Dr. Handel, the senior author, is a well-respected plastic surgeon at the UCLA School of Medicine.

Capsular contracture – or abnormal firmness of the breasts due to a scar tissue build-up around the breast implant – is arguably the #1 unsolved problem of breast implant surgery. It’s unpredictable and very frustrating for surgeon and patient.

This study, which admittedly is somewhat limited in power due to the small number of patients enrolled, found that in women who presented with capsular contracture of the breast, treatment with Singulair for three months significantly improved the softness of the breast. Thirty-seven percent (37%) had complete resolution of their capsular contracture, and 26% improved partially. It worked better for women with early symptoms, and not as well for women with a firm, established capsule.

Interestingly, I had a chance to speak with Dr. Handel about this at the recent ASAPS meeting in Washington, D.C. Based on this study, he now puts all of his first-time breast augmentation patients on Singulair, beginning the day after surgery….which is what we’ve been doing as well. (Isn’t it great when a respected expert agrees with you?)

Singulair, of course, is FDA-approved for use in asthma and allergy conditions in both adults and children. Its use for breast-implant care is “off-label”. It seems, however, that the anti-inflammatory effect it has for airways and sinus cavities also works in preventing the inflammation around an implant, which is one of the key factors in capsular formation.

I’ve also previously tried the related drug, Accolate, for women with stubborn or recurrent capsules. While Accolate seems to be a little more powerful in its effect than Singulair, Accolate can cause an elevation in liver enzymes, so monitoring with blood tests is important to do. Singulair seems to have fewer side effects.

Further large scale testing remains to be done….but this study is a great start.

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