Zafirlukast (Accolate): A new treatment for capsular contracture

Schlesinger, Sabrina; Ellenbogen, Richard G.; Desvigne, Michael N; Svehlak, Steven; Heck, Robert

doi:10.1067/maj.2002.126753

Cited by 74 publications

(54 citation statements)

References 22 publications

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“…The result is an increase in the collagen matrix found in scar tissue. This response is directly inhibited by LTRAs and appears to reduce the rate of capsular contracture (14,24). Although it is generally accepted that the macrophage and mast cell play an important role in wound healing, their precise role in the formation of capsular contracture is not fully understood.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with longstanding contracture who are neither surgical candidates nor wish to undergo surgery, zafirlukast may however effectively reduce both pain-and the distortion of the breast capsule (13)(14). The use of zafirlukast needs a careful monitoring as normal doses have been reported to cause liver failure in a very small number of patients, most of whom were women who presented anorexia, right upper quadrant pain, pruritus and jaundice.…”

Section: Discussionmentioning

confidence: 99%

“…Use of LTRAs to diminish the early inflammatory process induced, in large part, by the macrophage and mast cell may indeed impede further cellular mechanisms, such as myofibroblast activity, fibroblast proliferation and collagen deposition. The mechanism by which zafirlukast reduces or prevents capsular contracture is not yet completely clear and deserves further investigation (13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that the fluid retained around the breast implant following surgery causes ongoing inflammation. Pharmacological inhibition of the inflammatory process has, indeed, now become the main focus of research (7)(8)(9)(10) , and LTE 4 ) and their presumed suppressive effect on myofibroblasts, two factors presumed to cause contracture (13)(14)(15)(16)(17). In November 1996, the Food and Drug Administration approved the use of zafirlukast, a leukotriene receptor antagonist (LTRA), for the treatment of asthma.…”

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confidence: 99%

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Effects of Zafirlukast on Capsular Contracture: Controlled Study Measuring the Mammary Compliance

Scuderi

Mazzocchi

Rubino

2007

Int J Immunopathol Pharmacol

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Capsular contracture is a highly distressing, difficult complication after breast augmentation for both the patient and the surgeon. Although capsular contracture is a multifactorial process, one common denominator in the successful treatment of this complication is believed to be the abatement of inflammation. Leukotriene antagonists have recently emerged as effective prophylactic agents in reactive airway diseases. Anecdotal reports have indicated that zafirlukast (Accolate, AstraZeneca) effectively reverses capsular contracture. A prospective study of capsular contracture in 120 female patients in whom a total of 216 prostheses were implanted was performed. The hardness of capsular contracture was assessed by means of the mammary compliance method (Anton Paar Mammacompliance system). The patients were divided into two groups: patients in group A received zafirlukast for a 6-month period, while those in group B received vitamin E. The results show a significant decrease of the values of breast compliance after 6 months in group A but not in group B and that the variation in compliance after 6 months in group A compared to group B is statistically significant. In zafirlukast-treated patients, we observed a reduction in mammary compliance of 7.69% after 1 month, 16.78% after 3 months and 24.01% after 6 months. The present study suggests that zafirlukast may be effective in reducing pain and breast capsule distortion in patients with longstanding contracture who are either not surgical candidates or who do not wish to undergo surgery. Capsular contracture is the most common problem and cause of patient dissatisfaction following augmentation mammaplasty and mammary reconstruction with breast implants; the reported rates of this complication range from 0.5 to 30% (1-2).Every patient who undergoes implantation with an alloplastic implant experiences capsules around the prostheses. Breast firmness that is so marked that it results in a painful, hard breast, occasionally with visible distortion, has been termed fibrous capsular contracture (3)(4)(5). A number of intra-operative and post-operative factors may be linked to capsular contracture. Unfortunately, as few strictly-controlled studies have been conducted to investigate the causes and possible prevention ofcapsular contracture, there are as yet no definite data on the aetiopathogenesis of this complication (4-5).A number of treatments designed to reverse capsular contracture have also been proposed and used, all with varying success. These treatments may be either surgical (i.e. capsulotomy or capsulectomy in which the implant can be replaced or the plane of placement changed) or pharmacological (such

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Effects of Zafirlukast on Capsular Contracture: Controlled Study Measuring the Mammary Compliance

Scuderi

Mazzocchi

Rubino

2007

Int J Immunopathol Pharmacol

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“…As a consequence, some authors have attempted to clarify the issue of the mechanisms involved with this drug in the prevention and treatment of capsular contracture 5,8,[10][11][12][13][14][15][16][17][18] . Accordingly, new investigations are important to confirm the beneficial effect of this drug.…”

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confidence: 99%

Effect of zafirlukast on capsular contracture around silicone implants in rats

et al. 2012

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PURPOSE:To evaluate the effect of zafirlukast on capsular contracture around silicone implants by measuring the pressure within the implant, using a rat experimental model. METHODS: Forty adult female Wistar rats were used. Each one received two silicone implants, one with smooth-surface and the other with textured-surface. They were randomly divided into four groups (n=10). The rats of control group I were sacrificed after the implants. The remaining animals were subjected to a daily regimen of intra-peritoneal injection for a period of 90 days and they were distributed as follows: control group II received 0.9% physiological saline solution; experimental group I received zafirlukast 1.25 mg/kg; and experimental group II received zafirlukast 5 mg/kg. The measurement of intra-implant pressure of control group I was determined on the surgery day and in other groups on the ninetieth day, after being sacrificed. RESULTS: In the evaluation of textured implants there was an increase of internal pressure in the control group II, and there was no increase in the experimental groups. Compared to the controls there were not significant differences in smooth implants. CONCLUSION: Zafirlukast reduced the risk of developing capsular contracture around silicone implants with textured surface. Key words: Breast Implants. Implant Capsular Contracture. Leukotriene Antagonists. Rats. RESUMO OBJETIVO: Avaliar o efeito do zafirlukast na contratura capsular ao redor de implantes de silicone, através da aferição da pressão intra-implante, utilizando-se um modelo experimental de ratos. MÉTODOS: Quarenta ratos fêmeas Wistar foram utilizados. Cada um recebeu dois implantes de silicone, sendo um com superfície lisa e outro texturizada. Foram divididos aleatoriamente em quatro grupos (n=10). Os ratos do grupo controle I foram sacrificados após o implante. O restante dos animais foi submetido a um regime diário de injeção intraperitoneal por um período de 90 dias e foram distribuídos: grupo controle II recebeu solução salina fisiológica 0,9%, grupo experimental I recebeu zafirlukast 1,25 mg/kg, e grupo experimental II recebeu zafirlukast 5 mg/kg. O grupo controle II recebeu solução salina; grupo experimental I, 1,25 mg/kg/dia de zafirlukast; grupo experimental II, 5mg/kg/dia de zafirlukast. A aferição da pressão intra-implante do grupo controle I foi averiguada no dia do ato operatório, e nos outros grupos no nonagésimo dia, após serem sacrificados. RESULTADOS: Na avaliação dos implantes texturizados houve aumento da pressão interna no grupo controle II e, não se observou aumento nos grupos experimentais. Na comparação com os controles não foram observadas diferenças significativas nos implantes lisos. CONCLUSÃO: O Zafirlukast reduziu o risco de desenvolver contratura capsular em torno de implantes de silicone com superfície texturizada. Descritores: Implantes de Mama. Contratura Capsular em Implantes. Antagonistas de Leucotrienos. Ratos.

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Breast implants: the good, the bad and the ugly. Can nanotechnology improve implants?

Puskás

Luebbers

2011

WIREs Nanomed Nanobiotechnol

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This advanced review will discuss the history of implants used in breast reconstruction and augmentation, the most frequently performed plastic surgery today. Currently, only silicone rubber-based silica nanocomposite implants are available in the United States. The most prevalent issues involving breast implants include capsular contracture, gel bleed, implant rupture, and infection. In the past, studies have also been reported which linked breast implants to increased incidence of systemic diseases such as autoimmune disease, various forms of cancer, and psychological disease. The goal of this review is to survey the literature from the perspective of material science. It is also largely unnoticed that nanotechnology is involved: the silicone rubber shell is reinforced with nanosilica so implants appear to be homogeneous and crystal clear. We are hoping that this review will contribute to a better understanding of the controversial issues and motivate material scientists and medical doctors to work together to develop alternatives based on new nanotechnology for the women who opt for a device made of synthetic materials.

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Zafirlukast (Accolate): A new treatment for capsular contracture

Abstract: Zafirlukast appears to effectively soften early capsular contracture and may prevent the formation of capsular contracture in those patients at risk. (Aesthetic Surg J 2002;22:329-336.).

Cited by 74 publications

References 22 publications

Effects of Zafirlukast on Capsular Contracture: Controlled Study Measuring the Mammary Compliance

Effects of Zafirlukast on Capsular Contracture: Controlled Study Measuring the Mammary Compliance

Effect of zafirlukast on capsular contracture around silicone implants in rats

Breast implants: the good, the bad and the ugly. Can nanotechnology improve implants?

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