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Asthma medcations help patients with breast implant complications breathe easy.

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Tightening or thickening of scar tissue around breast implants Reported occurrences vary widely: between 2% - 30%

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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

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Antibiotics Massage Compression Textured Implants Oral Vitamin E therapy Steroids Capsulotomy/Capsulectomy Open Closed

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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)

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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

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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)

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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.

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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!

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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

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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

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Methods: 37 bilateral submuscular augmentation mammaplasties (74 breasts). Saline smooth-walled implants Post-op protocol- Massaging (early) 400 I.U. vitamin E orally twice daily (4 weeks)

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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.

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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

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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