The Prophylactic Use of Leukotriene Inhibitors in Primary Silicone Breast Augmentation: What Works and What Does Not

Capsular contracture continues to be the most common complication of silicone gel breast augmentation, affecting thousands of patients yearly worldwide.  The role of leukotriene inhibitors used immediately postoperatively to potentially influence the development of capsular contracture is unknown.  The purpose of this study was to evaluate the incidence of capsular contracture among women undergoing primary silicone gel breast augmentation, performed by one surgeon with a standardized technique, with or without postoperative leukotriene inhibitor therapy.

Between 2007 and 2012, 1102 consecutive women undergoing primary smooth silicone gel breast augmentation were retrospectively evaluated.  All underwent augmentation with smooth surface, Mentor Memory Gel implants, utilizing a dual plane technique, and either periareolar or inframammary approaches.  All patients were treated with antibiotic irrigation and implants were inserted with the aid of a sterile barrier/nipple shield.  Patients were voluntarily treated with either no leukotriene inhibitor postoperatively, Singulair (montelukast) for three months, or Accolate (zafirlukast) for three months.  All patients received detailed informed consent for the off-label use of leukotriene inhibitors.  Liver function studies were obtained for all patients undergoing accolate therapy after one month of therapy.  The presence of capsular contracture was measured by a simplified Baker scale at one year postoperatively. 

Patients receiving Accolate therapy (n = 520) demonstrated an encapsulation rate of 2.3%, (p<0.05).  Women receiving Singulair therapy (n = 247) had an encapsulation rate of 3.6%.  Patients not receiving leukotriene inhibitor therapy postoperatively had an encapsulation rate of 4.8%.      72% of patients underwent a periareolar approach, while 28 % had an inframammary incision.  The ratio of patients undergoing each incision type was consistent among the groups studied.  There were no long-term complications among patients evaluated.

Accolate therapy used for three months postoperatively was associated with significantly  lower capsular contracture rates compared to untreated patients at one year follow-up.   Singulair demonstrated lower contracture rates than controls, but the differences were not statistically significant.   Although the use of leukotriene inhibitors was safe among the patients studied with no long-term complications, the author suggests that further studies be done evaluating the benefits and risks of  leukotriene inhibitors prior to routine prophylactic use in breast augmentation patients.