St. Louis Plastic Surgeon on Accolate for Capsular Contracture

Posted: May 21, 2012 in Board Certified Plastic Surgeon Breast Procedures Breast Surgery Capsular Contracture

Accolate for Capsular Contracture

The drug Accolate has been proposed as a treatment for capsular contracture since 2002. At that time there was a report of a series of patients with contractures treated with that drug and it appeared to soften early contractures. Accolate (zafirlukast), along with Singular (montelukast), is a type of drug called leukotriene receptor antagonists. It is used to treat asthma by blocking the action of smooth muscle cells that tighten the airways. Myofibroblasts, the cells which cause contraction of the scar surrounding breast implants, are anatomically similar to smooth muscle cells and have these same receptors.

Since then there has been few scientific studies attempting to validate the effectiveness of this treatment. A series of thirty seven patients from Northwestern with smooth surfaced, saline-filled implants placed submuscularly with mild contracture showed a statistically significant response. A series of 60 patients in Italy showed softening of their capsular contracture compared to a similar number treated with vitamin E. A series of 19 patients from UCLA were treated with Singular and the majority showed improvement, better in those with mild contracture. Studies with silicone implants in rats treated with Accolate demonstrated thinner capsules in one study and less internal pressure within the capsule in another study.

In short there is a logical basis for the use of Accolate to treat capsular contracture, and promising reports. But after ten years there has not yet been published any prospective, randomized, controlled study with large numbers of patients in this country which demonstrates the effectiveness of Accolate for either the prevention of formation of tight capsules, or for the treatment of established capsular contracture.

The package insert notes that Accolate should not be taken by women who are pregnant, breast feeding, or have a history of liver disease. There are multiple possible drug interactions with Accolate including Coumadin, calcium channel blockers, and erythromycin.

If you have any questions, please feel free to contact my office.

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