Capsular Contracture and Accolate - Cosmetic Surgery Forums - Breast Augmentation, Breast Implants, Breast Surgery

Bailey · 10-13-2009, 03:17 PM

CAPSULAR CONTRACTURE STUDIES

Other Remedies for Capsular Contracture:

Leukotriene antagonists (Accolate) which is indicated for the use of asthma and lung diseases - has been potentially useful in counteracting the inflammatory pathway which leads to a dense collagen membrane around the breast implant or prosthesis. This ends up preventing contracture of the capsule. Not every patient will respond with this medication however.

Prescription Drug – Accolate (Zafirlukast)

Accolate whose generic name is Zafirlukast - is an oral leukotriene receptor antagonist (LTRA) for the maintenance treatment of asthma - often used in conjunction with an inhaled steroid and/or long-acting bronchodilator. It is available as a tablet and is usually dosed twice daily. Another leukotriene receptor antagonist is generic name which is montelukast or Singular, which is usually taken just once daily.

Both of these medications have shown great promise with the reduction of Capsular Constriction occurrence – along with existing contracture conditions if the contracture is not that far along.

Using prescription drug therapy with Accolate or Singular seems to work best if the Capsular Constriction is at the Baker Grade II level, so early detection of this is of utmost concern, so that you can get started on this drug regimen.

Accolate (Zafirlukast) is marketed and distributed by Astra-Zeneca with the brand names Accolate, Accoleit, and Vanticon. This medication comes in pill form to treat asthma. Zafirlukast mode of action in targeting capsular contracture works by it’s leukotriene receptor inhibitor which prevents the common inflammatory response caused by certain components of white blood cells called leukocytes.

Zafirlukast when being prescribed for asthma blocks the action of the cysteinyl leukotrienes on the CysLT1 receptors, thus reducing constriction of the airways, build-up of mucus in the lungs and inflammation of the breathing passages.

With capsular constriction one school of thought is that it comes from an overactive immune response, just like an asthma attack would be triggered. It is this drug Zafirlukast that literally fights the body’s immune reaction by preventing contracture from forming, and slowly softening and possibly releasing pre-existing low level contracture conditions.

Benefits of using Accolate with patients who have capsular contracture:

Asthma Medication may have Benefits in Treating most Common Problem of Breast Implant Surgery

Journal Article from Dr. Schlesinger, MD of Maui, Hawaii.

Preliminary Report Slated for ASAPS Meeting, Las Vegas
NEW YORK, NY (April 12, 2002) Accolate approved by the U.S. Food and Drug Administration for the treatment of asthma; may be the newest weapon against capsular contracture, the undesirable breast firmness that sometimes follows breast augmentation or reconstruction with implants. A preliminary report based on several surgeons’ clinical experience will be presented at a special session on research and innovative technology during the Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), April 27-May 3, in Las Vegas.

Capsular contracture, the most frequent problem following breast implant surgery, occurs when the naturally-resulting scar tissue around the implant contracts, squeezing the implant and making the breast feel firm. In severe cases, capsular contracture may cause significant breast distortion and discomfort. When severe contracture occurs, the only remedy is surgery; even then, the problem may recur months or years later.

Plastic Surgeon Larry Schlesinger, MD, of Maui, HI, reports on a series of cases in which the asthma medication Accolate was prescribed, as an off-label use, for capsular contracture following breast augmentation or reconstruction with implants. "In many cases, the patients and surgeon noted a very significant softening and improved appearance of the breast following treatment with Accolate for a period of one to three months," says Dr. Schlesinger. "For some women who otherwise would have needed surgical correction of their contracture, surgery was no longer needed.

ASTHMA MEDICATION

Dr. Schlesinger says that he has been using Accolate for approximately three years and has found it most effective in treating early-phase contracture (less than six months) and as a preventative treatment in patients considered "high risk" for contracture; this group includes those with a history of previous capsular contracture and patients with a tendency toward hypertrophic scarring. However, he says there has also been some success in using the drug to treat established contracture.
"Our preliminary findings do not suggest that Accolate is the answer for every patients with contracture," advises Dr. Schlesinger. "For patients whose capsular contracture is severe and long-standing, meaning a year or more, surgical intervention is still the best option. But for patients who are not good candidates for surgery or elect not to undergo surgery – such as breast reconstruction patients who may have experienced capsular contracture following radiation therapy it may be possible to achieve some degree of improvement using Accolate"

Dr. Schlesinger’s results are based on a treatment of 20 milligrams of Accolate administered orally twice daily – the same dosage indicated for the preventative and chronic treatment of asthma in adults and children 12 years of age or older. From November 1996 through 1998, Accolate tablets were prescribed more than 4 million times for asthma treatment and, reportedly, the drug is well tolerated. Side effects may include headache (12.9%) and nausea (3.1%).”

Dr. Schlesinger’s clinical experience with Accolate is very preliminary, but is consistent with other research suggesting that certain medications may be useful in helping to prevent or improve the symptoms of capsular contracture in properly selected patients," says James Baker, J r., MD, Breast Surgery Committee chair for the American Society for Aesthetic Plastic Surgery.

The effect of zafirlukast (Accolate) on early capsular contracture in the primary augmentation patient: A pilot study.

R. Reid, S. Greve, L. Casas
Aesthetic Surgery Journal, Volume 25 , Issue 1 , Pages 26 - 30
The development of capsular contracture following breast augmentation presents a challenge to the plastic surgeon. Treatment of capsular contracture with the leukotriene antagonist zafirlukast (Accolate, AstraZeneca, Wayne, PA) has received much attention in the media; however, there is limited proof of its effectiveness.

The purpose of this study was to prospectively examine a single surgeon's experience using zafirlukast in the treatment of capsular contracture in primary, submuscular breast augmentation with saline-filled, smooth-walled implants.

Thirty-seven patients (74 breasts) who underwent primary sub-muscular breast augmentation with saline-filled, smooth-walled implants were evaluated at 1, 2, 4, 6, 12, 24, and 48 weeks postoperatively by 3 independent observers and rated for capsular contracture using a modification of the Baker classification. Patients who demonstrated any capsular contracture (higher than modified Baker 1.0) were offered off-label use of zafirlukast 20 mg PO BID for 3 or 6 months after full informed consent was reviewed and accepted.

In addition, patients were offered liver function chemistries at the start of treatment and at 1, 3, and 6 months following zafirlukast treatment. The patients were assessed for implant mobility and capsular contracture at the initiation of leukotriene therapy and then again at 3- and 6-month time points.

Forty-one breasts in this series (55.0%) were found to have early, mild capsular contracture. Specifically, 25 breasts were graded 1.5 (33.8% of total), 14 breasts graded 2.0 (18.9%), 1 breast graded 2.5 (1.4%), and 1 breast graded 3.0 (1.4%). Mean follow-up was 6.3 months. A positive response (complete or partial) was seen in a statistically significant proportion of treated breasts (75.7%, P < 0.05).

This response was maintained on a long-term basis, with a mean follow-up of 16.5 months.

Zafirlukast appears effective in treating early capsular contracture after primary sub-muscular breast augmentation using saline-filled, smooth-walled implants. Further prospective studies with control groups and long-term follow-up will be needed to address many unanswered questions, including whether leukotriene inhibitors have long-term effects on capsular contracture following breast augmentation.

Other Methods of Treating Capsular Contracture

Antibiotic Breast Irrigation

Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study.

Adams WP Jr, Rios JL, Smith SJ.

Department of Plastic Surgery, Parkland Health and Hospital System, Dallas, Texas, USA. dr@dr-adams.com

BACKGROUND: Capsular contracture remains one of the most commonly reported complications in aesthetic and reconstructive breast patients. Previous in vitro studies from the authors' laboratory have recommended an new triple antibiotic povidone-iodine irrigation (2000) and subsequently a triple antibiotic non-povidone-iodine-containing irrigant (2001) to optimize broad-spectrum coverage of various bacteria implicated in capsular contracture; however, the clinical efficacy of these in vitro studies remains unproven. The purpose of this study was to determine the clinical efficacy for the previously reported triple antibiotic breast irrigation. The cost-effectiveness of universal application of irrigation solutions in breast prosthesis surgery was analyzed as well.

METHODS: Patients undergoing aesthetic and reconstructive breast implant procedures were treated with a standardized operative technique, including the use of triple antibiotic breast irrigation by a single surgeon. Capsular contracture was assessed using a simplified Baker scale and graded by two independent caregivers to maximize objectivity and consistency. Additional complications were also recorded, including re-operation. Patient charges for antibiotic irrigation and re-operation for contracture were determined and compared.

RESULTS: A total of 335 patients operated on since 1997 were evaluated prospectively. They ranged in age from 18 to 86 years, and the mean follow-up was 14 months (range, 6 to 75 months)The rate of grade III/IV capsular contracture in the study groups was 1.8 percent for patients undergoing primary breast augmentation. Patients undergoing augmentation-mastopexy had a grade III/IV contracture rate of 0 percent. Breast reconstruction patients had a 9.5 percent rate of grade III/IV contracture.

CONCLUSIONS: Triple antibiotic breast irrigation is clinically associated with a low incidence of capsular contracture compared with other published reports, and its clinical efficacy supports previously published in vitro studies. Application of triple antibiotic irrigation is recommended for all aesthetic and reconstructive breast procedures and is cost effective.

iluvlips · 04-20-2010, 10:22 PM

Bump

maybellineo · 04-21-2010, 10:48 AM

Hi Bailey:

I just read on a website that a CA. PS feels that most CC is caused by bacterial
infection from placing the implant through the areola. The implant passes by the milk ducts that he feels are filled with bacteria. That is why he cuts in the crease for some of his patients.

Maybellineo

Bailey · 04-21-2010, 05:06 PM

Quote:

Originally Posted by maybellineo

Hi Bailey:

I just read on a website that a CA. PS feels that most CC is caused by bacterial
infection from placing the implant through the areola. The implant passes by the milk ducts that he feels are filled with bacteria. That is why he cuts in the crease for some of his patients.

Maybellineo

I have heard this too many times. There are a lot of theories out there.
Which PS are you going to in San Diego hon?

maybellineo · 04-21-2010, 05:26 PM

Dr. Tom Pousti: Please don't tell me any bad things about him!!!!

Bailey · 04-21-2010, 05:37 PM

Quote:

Originally Posted by maybellineo

Dr. Tom Pousti: Please don't tell me any bad things about him!!!!

OMG!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

hon, he is one of the BEST!! I am so happy for you

He is amazing with his BA's. You are going to be so very happy.

The best of the best Maybelline

maybellineo · 04-21-2010, 05:46 PM

Thank God!! Bailey. I was so worried. I have to admit I gave the Dr's down here enough chances to get this right. Bailey, can you look at my thread of my before and then the links of what I want, and give me suggestions as to how big I should get my implants. To get a B cup. but I still want to try and cover up my scars if possible. If he can't, he will revise them altogehter.

Maybelline

10-13-2009, 03:17 PM	#1 (permalink)
Bailey ♥♥Administrator♥♥ Join Date: May 2008 Location: Southern California Posts: 14,941 Thanks: 1,209 Thanked 2,717 Times in 1,432 Posts My Mood:	Capsular Contracture and Accolate CAPSULAR CONTRACTURE STUDIES Other Remedies for Capsular Contracture: Leukotriene antagonists (Accolate) which is indicated for the use of asthma and lung diseases - has been potentially useful in counteracting the inflammatory pathway which leads to a dense collagen membrane around the breast implant or prosthesis. This ends up preventing contracture of the capsule. Not every patient will respond with this medication however. Prescription Drug – Accolate (Zafirlukast) Accolate whose generic name is Zafirlukast - is an oral leukotriene receptor antagonist (LTRA) for the maintenance treatment of asthma - often used in conjunction with an inhaled steroid and/or long-acting bronchodilator. It is available as a tablet and is usually dosed twice daily. Another leukotriene receptor antagonist is generic name which is montelukast or Singular, which is usually taken just once daily. Both of these medications have shown great promise with the reduction of Capsular Constriction occurrence – along with existing contracture conditions if the contracture is not that far along. Using prescription drug therapy with Accolate or Singular seems to work best if the Capsular Constriction is at the Baker Grade II level, so early detection of this is of utmost concern, so that you can get started on this drug regimen. Accolate (Zafirlukast) is marketed and distributed by Astra-Zeneca with the brand names Accolate, Accoleit, and Vanticon. This medication comes in pill form to treat asthma. Zafirlukast mode of action in targeting capsular contracture works by it’s leukotriene receptor inhibitor which prevents the common inflammatory response caused by certain components of white blood cells called leukocytes. Zafirlukast when being prescribed for asthma blocks the action of the cysteinyl leukotrienes on the CysLT1 receptors, thus reducing *constriction* of the airways, build-up of mucus in the lungs and *inflammation* of the breathing passages. With capsular constriction one school of thought is that it comes from an overactive immune response, just like an asthma attack would be triggered. It is this drug Zafirlukast that literally fights the body’s immune reaction by preventing contracture from forming, and slowly softening and possibly releasing pre-existing low level contracture conditions. Benefits of using Accolate with patients who have capsular contracture: Asthma Medication may have Benefits in Treating most Common Problem of Breast Implant Surgery Journal Article from Dr. Schlesinger, MD of Maui, Hawaii. Preliminary Report Slated for ASAPS Meeting, Las Vegas NEW YORK, NY (April 12, 2002) Accolate approved by the U.S. Food and Drug Administration for the treatment of asthma; may be the newest weapon against capsular contracture, the undesirable breast firmness that sometimes follows breast augmentation or reconstruction with implants. A preliminary report based on several surgeons’ clinical experience will be presented at a special session on research and innovative technology during the Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), April 27-May 3, in Las Vegas. Capsular contracture, the most frequent problem following breast implant surgery, occurs when the naturally-resulting scar tissue around the implant contracts, squeezing the implant and making the breast feel firm. In severe cases, capsular contracture may cause significant breast distortion and discomfort. When severe contracture occurs, the only remedy is surgery; even then, the problem may recur months or years later. Plastic Surgeon Larry Schlesinger, MD, of Maui, HI, reports on a series of cases in which the asthma medication *Accolate* was prescribed, as an off-label use, for capsular contracture following breast augmentation or reconstruction with implants. "In many cases, the patients and surgeon noted a very significant softening and improved appearance of the breast following treatment with *Accolate* for a period of one to three months," says Dr. Schlesinger. "For some women who otherwise would have needed surgical correction of their contracture, surgery was no longer needed. ASTHMA MEDICATION Dr. Schlesinger says that he has been using *Accolate* for approximately three years and has found it most effective in treating early-phase contracture (less than six months) and as a preventative treatment in patients considered "high risk" for contracture; this group includes those with a history of previous capsular contracture and patients with a tendency toward hypertrophic scarring. However, he says there has also been some success in using the drug to treat established contracture. "Our preliminary findings do not suggest that *Accolate* is the answer for every patients with contracture," advises Dr. Schlesinger. "For patients whose capsular contracture is severe and long-standing, meaning a year or more, surgical intervention is still the best option. But for patients who are not good candidates for surgery or elect not to undergo surgery – such as breast reconstruction patients who may have experienced capsular contracture following radiation therapy it may be possible to achieve some degree of improvement using *Accolate" Dr. Schlesinger’s results are based on a treatment of 20 milligrams of Accolate* administered orally twice daily – the same dosage indicated for the preventative and chronic treatment of asthma in adults and children 12 years of age or older. From November 1996 through 1998, *Accolate* tablets were prescribed more than 4 million times for asthma treatment and, reportedly, the drug is well tolerated. Side effects may include headache (12.9%) and nausea (3.1%).” Dr. Schlesinger’s clinical experience with *Accolate* is very preliminary, but is consistent with other research suggesting that certain medications may be useful in helping to prevent or improve the symptoms of capsular contracture in properly selected patients," says James Baker, J r., MD, Breast Surgery Committee chair for the American Society for Aesthetic Plastic Surgery. The effect of zafirlukast (Accolate) on early capsular contracture in the primary augmentation patient: A pilot study. R. Reid, S. Greve, L. Casas Aesthetic Surgery Journal, Volume 25 , Issue 1 , Pages 26 - 30 The development of capsular contracture following breast augmentation presents a challenge to the plastic surgeon. Treatment of capsular contracture with the leukotriene antagonist zafirlukast (Accolate, AstraZeneca, Wayne, PA) has received much attention in the media; however, there is limited proof of its effectiveness. The purpose of this study was to prospectively examine a single surgeon's experience using zafirlukast in the treatment of capsular contracture in primary, submuscular breast augmentation with saline-filled, smooth-walled implants. Thirty-seven patients (74 breasts) who underwent primary sub-muscular breast augmentation with saline-filled, smooth-walled implants were evaluated at 1, 2, 4, 6, 12, 24, and 48 weeks postoperatively by 3 independent observers and rated for capsular contracture using a modification of the Baker classification. Patients who demonstrated any capsular contracture (higher than modified Baker 1.0) were offered off-label use of zafirlukast 20 mg PO BID for 3 or 6 months after full informed consent was reviewed and accepted. In addition, patients were offered liver function chemistries at the start of treatment and at 1, 3, and 6 months following zafirlukast treatment. The patients were assessed for implant mobility and capsular contracture at the initiation of leukotriene therapy and then again at 3- and 6-month time points. Forty-one breasts in this series (55.0%) were found to have early, mild capsular contracture. Specifically, 25 breasts were graded 1.5 (33.8% of total), 14 breasts graded 2.0 (18.9%), 1 breast graded 2.5 (1.4%), and 1 breast graded 3.0 (1.4%). Mean follow-up was 6.3 months. A positive response (complete or partial) was seen in a statistically significant proportion of treated breasts (75.7%, P < 0.05). This response was maintained on a long-term basis, with a mean follow-up of 16.5 months. Zafirlukast appears effective in treating early capsular contracture after primary sub-muscular breast augmentation using saline-filled, smooth-walled implants. Further prospective studies with control groups and long-term follow-up will be needed to address many unanswered questions, including whether leukotriene inhibitors have long-term effects on capsular contracture following breast augmentation. Other Methods of Treating Capsular Contracture Antibiotic Breast Irrigation Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Adams WP Jr, Rios JL, Smith SJ. Department of Plastic Surgery, Parkland Health and Hospital System, Dallas, Texas, USA. dr@dr-adams.com BACKGROUND: Capsular contracture remains one of the most commonly reported complications in aesthetic and reconstructive breast patients. Previous in vitro studies from the authors' laboratory have recommended an new triple antibiotic povidone-iodine irrigation (2000) and subsequently a triple antibiotic non-povidone-iodine-containing irrigant (2001) to optimize broad-spectrum coverage of various bacteria implicated in capsular contracture; however, the clinical efficacy of these in vitro studies remains unproven. The purpose of this study was to determine the clinical efficacy for the previously reported triple antibiotic breast irrigation. The cost-effectiveness of universal application of irrigation solutions in breast prosthesis surgery was analyzed as well. METHODS: Patients undergoing aesthetic and reconstructive breast implant procedures were treated with a standardized operative technique, including the use of triple antibiotic breast irrigation by a single surgeon. Capsular contracture was assessed using a simplified Baker scale and graded by two independent caregivers to maximize objectivity and consistency. Additional complications were also recorded, including re-operation. Patient charges for antibiotic irrigation and re-operation for contracture were determined and compared. RESULTS: A total of 335 patients operated on since 1997 were evaluated prospectively. They ranged in age from 18 to 86 years, and the mean follow-up was 14 months (range, 6 to 75 months)The rate of grade III/IV capsular contracture in the study groups was 1.8 percent for patients undergoing primary breast augmentation. Patients undergoing augmentation-mastopexy had a grade III/IV contracture rate of 0 percent. Breast reconstruction patients had a 9.5 percent rate of grade III/IV contracture. CONCLUSIONS: Triple antibiotic breast irrigation is clinically associated with a low incidence of capsular contracture compared with other published reports, and its clinical efficacy supports previously published in vitro studies. Application of triple antibiotic irrigation is recommended for all aesthetic and reconstructive breast procedures and is cost effective. __________________ The definition of Insanity.. is doing the same thing over and over.. expecting different results~ www.CosmeticSurgeryForums.com

04-20-2010, 10:22 PM	#2 (permalink)
iluvlips ♥VIP Member♥ Join Date: Mar 2009 Posts: 9,412 Blog Entries: 1 Thanks: 2,805 Thanked 1,951 Times in 1,447 Posts	Re: Capsular Contracture and Accola Bump

04-21-2010, 10:48 AM	#3 (permalink)
maybellineo VIP Member Join Date: Sep 2008 Posts: 52 Thanks: 12 Thanked 0 Times in 0 Posts	Re: Capsular Contracture and Accola Hi Bailey: I just read on a website that a CA. PS feels that most CC is caused by bacterial infection from placing the implant through the areola. The implant passes by the milk ducts that he feels are filled with bacteria. That is why he cuts in the crease for some of his patients. Maybellineo __________________

04-21-2010, 05:26 PM	#5 (permalink)
maybellineo VIP Member Join Date: Sep 2008 Posts: 52 Thanks: 12 Thanked 0 Times in 0 Posts	Re: Capsular Contracture and Accola Dr. Tom Pousti: Please don't tell me any bad things about him!!!! __________________

04-21-2010, 05:46 PM	#7 (permalink)
maybellineo VIP Member Join Date: Sep 2008 Posts: 52 Thanks: 12 Thanked 0 Times in 0 Posts	Re: Capsular Contracture and Accola Thank God!! Bailey. I was so worried. I have to admit I gave the Dr's down here enough chances to get this right. Bailey, can you look at my thread of my before and then the links of what I want, and give me suggestions as to how big I should get my implants. To get a B cup. but I still want to try and cover up my scars if possible. If he can't, he will revise them altogehter. Maybelline __________________

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