Effects of Zafirlukast on Capsular Contracture

The most common complication of breast augmentation is capsular contracture. This a common matter of concern among most plastic surgeons and patients.  Surgical intervention usually is required.   In 2002, the use of zafirlukast, a leukotriene inhibitor (a drug used for asthma treatment), was reported for the treatment of capsular contracture, with good results.

Clinical studies and experimental studies showed that capsular contracture responds favorably to treatment with zafirlukast. 

• Clinical findings according to some studies indicate that zafirlukast may reduce pain and breast capsule distortion for patients with long-standing contracture who either are not surgical candidates or do not wish to undergo surgery.
• In Spano's evaluation of the effectiveness of Zafirlukast on capsular contracture, the investigation showed improvement of the thickness of capsule around the implants in the Zafirlukast group.  The mean total thickness of the capsule around the implants was 161.97 microm in the zafirlukast-treated group compared with 345.98 microm in the control group (p < 0.001). Outstandingly, the collagen fibers and fibroblast layer were reduced in the zafirlukast-treated group compared to the controls.   Their study confirmed the effectiveness of this compound in preventing fibrosis and putatively also in reducing the extent of collagen reaction when a capsule has been formed.
• Another experimental study showed another leukotriene inhibitor, Montelukast, reduced the thickness, the inflammatory cell infiltrate and the myofibroblast content of the peri-implant capsules around silicone implants in their study. They lowered the expression of the fibrotic mediator, TGF-β, and inhibited the peri-implant capsular fibrosis.

Reference:

Bastos, et al. Histologic analysis of zafirlukast's effect on capsule formation around silicone implants. Aesthetic Plastic Surgery. 2007 Sep-Oct;31(5):559-65.

Scuderi, et al. The effects of zafirlukast on capsular contracture: preliminary report.  Aesthetic Plastic Surgery. 2006 Sep-Oct;30(5):513-20.

Scuderi, at al.  Effects of zafirlukast on capsular contracture: controlled study measuring the mammary compliance.  Int J Immunopathol Pharmacol. 2007 Jul-Sep;20(3):577-84.

Spano, et alReduction of capsular thickness around silicone breast implants by zafirlukast in rats. Eur Surg Res. 2008;41(1):8-14. doi: 10.1159/000121501. Epub 2008 Mar 27.