Treating Capsular Contracture After Breast Augmentation

Capsular contracture after breast augmentation is one of the most difficult problems faced by women who underwent breast augmentation.  Capsular contracture occurs when the collagen-fiber capsule shrinks, tightens and compresses the breast implant which may cause deformity of the breast implant.  When the capsule surrounding the breast implant contracts, the shape of the breast changes and may look deformed.  Often pain may occur after the formation of capsular contracture.  

Grading of Capsular Contracture after Breast Augmentation

  • 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

Reducing the Rate of Capsular Contracture

  • Placing the breast implant underneath the muscle either pure sub muscular or Dual-plane technique 
  • Using textured-breast implant may reduce capsular contracture
  • The use of antibiotic irrigation prior to placement of the breast implant may reduce the rate of capsular contracture
  • Minimal contact of the breast implant with the  skin of the patient during surgery before the insertion of the breast implant inside the breast.
  • Limiting the handling of the breast implant may reduce the capsular contracture rate.  The use of Keller Funnel to minimize the contamination of breast implants during surgery is promising but has not been clinically proven yet.

Zafirlukast as Treatment for Capsular Contracture

  • Zafirlukast (or Accolade at 20 mg po bid) appeared to soften capsular contracture in Baker's Grade III and IV capsular contracture.
  • Dramatic softening occurred after 1 or 3 months of treatment (1)
  • Reduced capsular contracture values are strictly related to the duration of drug intake. (2)
  •  A significant reduction and improvement of capsular contracture (complete or partial) was seen in a statistically significant proportion of treated breasts with Zafirlukast(75.7%, P < 0.05). This response was maintained on a long-term basis, with a mean follow-up of 16.5 months. (3)

Side Effects of Zafirlukast

  • Elevation of liver enzymes may occur after prolonged intake of Zafirlukast.  Although hepatitis is a rare side effect, one should notify your surgeon when this symptoms arises.  One should also stop taking this medication when abdominal pain occurs.  I recommend consulting your surgeon when one starts having symptoms with prolonged intake of Zafirlukast.


Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon, Houston Texas


  1. Schlesinger, et al.  Aesthet Surg J. 2002 Jul;22(4):329-36. doi: 10.1067/maj.2002.126753. Zafirlukast (Accolate): A new treatment for capsular contracture.
  2. Mazzochi, et al.  Int J Immunopathol Pharmacol. 2012 Oct-Dec;25(4):935-44. Effects of zafirlukast on capsular contracture: long-term results.  
  3. Reid, et al.  Aesthet Surg J. 2005 Jan-Feb;25(1):26-30. doi: 10.1016/j.asj.2004.12.003.  The effect of zafirlukast (Accolate) on early capsular contracture in the primary augmentation patient: a pilot study.


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