Mazzocchi M, Dessy LA, Alfano C, Scuderi N. Effects and Zafirlukast on capsular contracture: long-term results. International Journal of Immunopathology and Pharmacology. 2012 Oct;25(4):935-44. doi:10.1177%2F03946320120202500411 Although the exact eitopathogenesis of capsular contracture is still visible, the inflammatory response seems to play a role. Therefore, it is thought that the modification of the inflammatory response by drugs can reduce the frequency of capsular contractures. The leukotriene antagonist Zafirlukast (AstroZeneca) has been used off-label to determine whether it has an influence on the development of contractures. Animal studies have shown that when 5 mg/kg of zafirlukast per day have been injected around textured silicone implants, the capsules are thinner and more vascular with a lower collagen density [75,76], suggesting that the drug may be able to prevent the development of capsular contracture. It is generally accepted that submuscular placement, in which the implant is placed behind the major pectoral muscle, results in a lower incidence of capsular contracture than when the implant is placed directly under the skin, in a subgobotal subcornular placement [14,49,57]. However, both investments can still lead to contraction. Siggelkow et al. [3] reported that 21% of patients with submuscular placement had an increase in Baker placement, while 84% of patients who received subgular placement noted an increase.
A recent systematic review found that total rates of capsular contracture with subgobolous placement were 8.6%, while they were only 2.8% in submuscular placement [2]. However, these results are not universal, with some studies noting a difference between the anatomical position of the pouch and capsular contracture rates [12]. This suggests that submuscular placement should be preferred to subcornular placement to reduce future complications. Nevertheless, a meta-analysis containing all the most recent data is needed to fully assess the influence of localization on the development of capsular contracture, taking into account more modern implant models. Capsule contracture is traditionally classified using baker`s classification system, a subjective classification system based on the clinical outcomes of the doctor in the patient. It is divided into four classes: I and II are not clinically significant, because I describe a breast that looks and feels absolutely natural, and II describes a breast with minimal contracture, because the surgeon may say that the surgery has been performed, but there are no symptoms. Classes III and IV are clinically significant and symptomatic, where III describes moderate contracture with some firmness of the patient and IV describes severe contracture evident on observation and symptomatic in the patient [8]. Capsular contracture is one of the most common complications after breast implant surgery. Statistics on its frequency of occurrence can vary from 0.5% to 30%. A breast should be soft and flexible with a natural cloth, even a breast rebuilt after a mastectomy. .