Asthma medcations help patients with breast implant
complications breathe easy.
Slide 2
Tightening or thickening of scar tissue around breast implants
Reported occurrences vary widely: between 2% - 30%
Slide 3
Can occur anytime starting within weeks after treatment. Causes
not fully understood Greater risks with Infection Hematoma Smoking
High rates of recurrence after capsulotomy or capsulectomy
Slide 4
Antibiotics Massage Compression Textured Implants Oral Vitamin
E therapy Steroids Capsulotomy/Capsulectomy Open Closed
Slide 5
Baker classification system Grade I - the breast is normally
soft and looks natural Grade II - the breast is a little firm but
looks normal Grade III - the breast is firm and looks abnormal
(visible distortion) Grade IV - the breast is hard, painful, and
looks abnormal (greater distortion)
Slide 6
First anecdotal reports: asthma patients who began drug
treatments showed improvements in capsular contracture. When
accolate is prescribed, many patients show some improvement in
capsular contracture. Success rates--? Anecdotal Most reports
indicate that around 50%-60% show total or partial improvement
Lower recurrence than with other treatments Non-invasive
Slide 7
Slide 8
Disks of implant material placed dorsally in rats. 20 rats in
the control group. 20 rats treated with zafirlukast. Autopsy was
done at 77 days, measuring thickness of implant capsule. Plano, et
al. Eur Surg Res 2008;41:8-14 (DOI: 10.1159/000121501)
Slide 9
Each implant with its surrounding collagenic tissue was
excised. The collagen fibers and fibroblast layer were reduced in
the zafirlukast-treated group compared to the controls. Study
confirms the effectiveness of this compound in preventing fibrosis.
Putatively also in reducing the extent of collagen reaction when a
capsule has been formed.
Slide 10
345.98 M IN THE CONTROL GROUP 161.97 M IN THE
ZAFIRLUKAST-TREATED GROUP Youre like a brick. Ouch. I know. Ouch.
Youre built like a brick house! I know!
Slide 11
A study of rats receiving 2 implants each, with injected doses
of saline (control) or zafirlukast, showed smaller vessels, thinner
capsules, lower collagen density, and smaller numbers of mastocytes
and eosinophils in textured implants. Smooth implant results were
similar to control group. Bastos, et al. Aesthetic Plast Surg. 2007
Sep-Oct;31(5):559-65
Slide 12
Used 60 male rats, given excisional dorsal wounds (no
implants). Monteleukast vs. saline solution (control) delivered via
tube. Wound contraction rates were calculated. Histological
specimens were analyzed. Contraction rate of wounds (day 7) were
similar in all groups. Results: Later (days 7 and 14) collagen
maturation rates were significantly lowered in the study group.
Tolazzi et. Al, Aesthetic Plast Surg 2009 Jan. 33 (1) 84-89
Used modified Baker classification system: Class 1=breast
absolutely natural, augmentation undetectable Class 1.5=breast
soft, but implant is detectable by physical examination Class
2=mild firmness, prosthesis not detectable by examiner or patient
Class 2.5= mild firmness and implant detectable by examiner but not
patient Class 3=breast moderately firm and detectable by patient
Class 4=severe firmness, obvious from observation, with pain.
Slide 16
Based on regular evaluation of 2 independent observers Any
capsular contracture >=1.5 were given Accolate 20mg orally 2x
daily Assessed at 3- and 6-month points. 33 of 74 breasts (45%)
were rated Class 1 (no capsular contracture) 41 (55.0%) were found
to have early capsular contracture, including: 29 that have
completed the protocol with an endpoint of 6 months or reversal to
Class 1 12 scored as 1.5 15 as 2 1 as 2.5 1 as 3
Slide 17
At an average of 4.8 months: 16 breasts (55.2%) showed a
complete response to Accolate returned to Class 1 7 (24.1%) showed
a partial response (reduction in capsular contracture index of 0.5)
6 had no response (stayed the same or worsened) Total complete or
partial response to Accolate therapy within 6 months: 79.3%
Response was maintained over a mean follow-up of 16.5 months P