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Joe Gryskiewicz, Commentary, Aesthetic Surgery Journal, Volume 30, Issue 3, May/June 2010, Pages 409–410, https://doi.org/10.1177/1090820X10374106
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I still remember the exact point in time when I learned about the serendipitous finding of capsule softening from a leukotriene inhibitor.1 Was this really it? Did we finally have the cure? Was this finding based on the scientific method demonstrating cause and effect, or was it merely a correlation?
The article from Drs. Huang and Handel is a timely one, addressing exactly this issue. There are three important conclusions in this retrospective study: (1) capsules seemed to be softened or even prevented by treatment with montelukast (Singulair; Merck & Co., West Point, Pennsylvania); (2) lower-grade capsules responded better than higher-grade, thicker capsules; and (3) montelukast was well tolerated.
I prescribe Singulair in my own practice and have found clinical responses consistent with the authors’ findings, which are that some capsules resolve or improve and some do not. It is also my clinical impression that softer capsules (Baker grades I/II) can regress completely, whereas firmer capsules (grade III/IV) never resolve entirely. The lesson, just as the authors say, is to intervene as early as possible. In the introduction, they also review the well-known correlation between pocket location and capsular contracture rate, which is another important facet of the study. Six of their patients had their implants placed subpectorally and 13 were in the submammary plane, but it was demonstrated there was no correlation between pocket placements and treatment results in this series.
