Cosmetic Surgery Tips

How Long to Take Singulair After Breast Augmentation

Several published studies have shown that using Singulair (montelukast) for capsular contracture can be beneficial, particularly in the first 90 days following a primary augmentation procedure. Capsular contracture is a common complication of breast augmentation surgery, where scar tissue forms around the implant, causing the breast to become firm and distorted. Singulair, a medication typically used to treat asthma and allergies, has been found to help reduce inflammation and prevent the formation of excessive scar tissue in the breast. While more research is needed to fully understand the long-term effects of using Singulair for capsular contracture, the initial results are promising for improving outcomes in breast augmentation patients.

The optimal way to minimize the chance of capsular contracture is to choose a plastic surgeon for your breast augmentation that is experienced in the procedure and knowledgeable about steps that will lower the likelihood it will develop. However, even in the ideal surgical situation, there is no way to eliminate the risk.

The Lowdown on Capsular Contracture

Scar tissue is a natural byproduct of any surgical procedure, including breast augmentation. The formation of the tissue is not a problem unless the tissue contracts and forms a tight capsule around the implant that restricts movement and causes the breast to become hard. The tightening often occurs in the weeks following surgery, with most contractures developing within the first two years after breast augmentation. If the breast becomes hard later, it could be an indication the implant has ruptured.

There are varying degrees of capsular contracture, based on the Baker grading system:

Are you at risk?

Capsular contracture occurs in about 10 percent of the women that undergo breast augmentation. While there is no way to predict with certainty who will develop this condition, there are some factors that might heighten your risk:

While these risks can be somewhat straightforward to identify, the cause of a “silent” contracture (one that cannot be attributed to these events) is unknown. Most physicians believe a low-grade infection is the most likely culprit; however, that theory has not been proven currently. Despite the lack of solid information on the causes of capsular contracture, experienced physicians will take steps to lower the risk for their patients.

Prevention Techniques

Since prevention is the most efficient way to treat the problem before it occurs, Drs. William and Jeffrey Umansky take steps before and during all breast augmentation procedures to lower the risk of capsular contracture. While not all these options are appropriate for every patient, our surgeons will take whatever precautions they can without compromising the results of your procedure. Some of the steps we consider include:

Treating the Problem

If capsular contracture does begin to develop, earlier treatment may help you avoid the need for additional surgery. Umansky Plastic Surgery is one of the only plastic surgery offices in the San Diego area to offer a revolutionary ultrasound treatment developed by Aspen Rehabilitation. The procedure delivers ultrasound energy into the breast tissue, which can soften the early signs of contraction when combined with massage and compression therapy. While the treatment does not work on every patient, we have seen a substantial number of women respond favorably to this therapy and see relief from contracture without the need for surgery.

How Long to Take Singulair for Capsular Contracture

Many patients considering undergoing a breast augmentation have likely come across the term “capsular contracture” in their research. A known complication of breast augmentations, a capsular contracture is basically a painful and hard breast that can result after a breast procedure. Below we go over what exactly causes a capsular contraction and what patients can do after surgery to avoid it.

What Causes Capsular Contracture? Once a breast implant is in place, fibrous scar tissue naturally forms around it, creating a tissue capsule. This tissue capsule is usually soft or slightly firm, not noticeable, and helps to keep the implant in place. In some women, a tissue capsule forms that is unusually hard and dense, which ends up tightening around the implant and squeezing it. This condition, called capsular contracture, can cause chronic pain and distortion in the shape of the breast. Usually, this condition is caused by a hematoma (build-up of blood tissue) around the implant. A hematoma can form from some form of trauma, like radiation or a car accident.

Is it Common? Capsular contracture is the most common complication after breast surgery, but luckily, it only occurs in about 10.6% of those who have a breast augmentation. While they can be very uncomfortable, capsular contractures are not life threatening. Corrective surgery can fix the issue.

How Can I Avoid it? While there are certain events that are out of a patient’s control when it comes to avoiding capsular contracture, such as a car accident or other form of trauma, there are also many preventative measures that can be taken to avoid the complication from occurring. According to Dr. Gray, one of the ways he tries to reduce his patients’ risk of capsular contracture is by prescribing them with Singulair asthma medicine. According to many small studies, drugs in this class have been proven to cut down on capsular contracture. Additionally, capsular contracture can be avoided by using a clean surgical technique, by ensuring all post-op instructions are followed, and by wearing the prescribed compression garment as directed.

accolate vs singulair for capsular contracture

In the current study, Singulair was found to be helpful in capsular contracture reduction, but the differences were less impressive than with Accolate and not statistically significant. Because both medications are known to be leukotriene inhibitors, why would one drug be more useful than the other?

The clinical pharmacology and recent research studies suggest possible explanations for these findings. Three cysteinyl leukotrienes, leukotriene C4, leukotriene D4, and leukotriene E4, are products of arachidonic acid metabolism and are released from cells associated with the inflammatory response. These compounds bind to cysteinyl leukotriene receptors that are found on smooth muscle cells and inflammatory cells. When leukotrienes bind to the cysteinyl leukotriene receptor, multiple effects, including cellular contraction, edema, and altered cellular activity associated with inflammation, may occur. Montelukast (Singulair) inhibits the actions of one leukotriene, leukotriene D4, at the cysteinyl leukotriene receptor.18

Zafirlukast (Accolate) is a competitive receptor antagonist for leukotrienes, and is known to antagonize the contractile activity of three different leukotrienes, including leukotriene C4, leukotriene D4, and leukotriene E4. These leukotrienes are associated with the inflammatory process, smooth muscle contraction, and cellular contraction.19 Zafirlukast (Accolate) competitively inhibits three different leukotrienes, rather than the one leukotriene inhibited by Montelukast (Singular). Although there is no evidence that Accolate is more potent in asthma treatment than Singulair, it may be that it may offer a more robust effect on inhibiting the encapsulation process. Furthermore, the leukotrienes that Singulair does not inhibit, leukotriene C4 and leukotriene E4, may be important in the pathogenesis of capsular contracture. Further studies will be necessary to characterize the differences between these medications on capsular contracture.

how to treat capsular contracture at home

For years, the benefits of fish oils, specifically, omega-3 fatty acids, have been touted to include a reduction of risk factors in heart disease, to fight anxiety and depression, and to reduce inflammation among others. Did you know that a group of researchers in Italy have recently suggested that omega 3 fatty acids may also reduce the risk of capsular contracture?

In a recent study published in the Journal of Plastic and Reconstructive Surgery, a group of researchers tested the effect of omega-3 fatty acids on the formation of capsules around silicone gel implants. What they found, offers hope for the treatment of capsular contracture.

Capsular contracture involves the formation of scar tissue around breast implants. The scar tissue acts to protect the implant from its surroundings. This tissue consists of multiple components, which can thicken and even “squeeze” the implant over time, causing hardening and /or displacement of the implant. The risk of this “capsular contracture” occurring is reported at 5-20% of implants. The best treatment that we have to date is to surgically remove the scar tissue or capsule and to position the implant in a new pocket when possible. Unfortunately, time and studies have told us that once you have a capsular contracture that you are more likely to redevelop that capsule, even with treatment.

So, what are your options? Omega-3 fatty acids reduce inflammation. Excessive inflammation is thought to be present in capsular contracture. This study showed that when the treatment group received omega-3 oil daily, that the capsule that formed around the implant was thinner and more transparent than the capsule that formed in the group that received the placebo (in this case water). Up until now, our only non-surgical treatment involved the use of Montelukast, an asthma medication that was inconsistent in offering relief. Omega-3 fatty acid supplements offer a simple and promising method of preventing or reducing capsular contracture after silicone breast implant surgery.

The take away is that more research is needed. But, if you like fatty fish such as salmon, and you have breast implants, there may be an additional benefit to enjoying what you already love.

If you have breast implants, and you are concerned about capsular contracture or other implant-related problems, you may want to reach out to New Jersey Plastic Surgeon Dr. Friedlander at (973) 912-9120 to schedule your confidential consultation.

Vitamin E for Capsular Contracture

Capsular Contracture occurs in about 5% (more in post-mastectomy) of breast augmentation patients. While it occurs rarely, it is one of the most often seen complications following the procedure. Scar tissue may create a constricting or tight capsule around the implant as the patient heals. This capsule continues to contract, becoming firm, sliding the implant out of place, and can be uncomfortable or painful.

Cause of Capsular Contracture

The majority of Capsular Contracture cases have no known cause. This complication may be the result of an infection, radiation therapy, trauma to the breast, or the use of breast implants that are too large for the patient. Other causes of this condition may be seromas and hematoma. Seromas is the collection of fluid under the breast implant following the surgery; and, hematomas is bleeding under the skin.

Grades of Capsular Contracture

The signs of Capsular Contracture occur over a period of time. To measure the degree of this complication, doctors use the Baker Grading system and include:

Non-Surgical Treatment Options


High-Dose Vitamin E

Vitamin E has been found to soften scars on the skin. When taken orally for this condition, however, results show no significant improvement. Furthermore, high doses of Vitamin E is thought to increase the risk of cardiovascular disease.


There is no clinical effect observed with antibiotics even though the culprit in Capsular Contracture is bacteria.

Leukotriene inhibitors

Singular and Accolate are medication approved by the FDA to reduce the frequency and severity of asthma attacks and have been useful in a small about of cases of Capsular Contracture. Additionally, Accolate has been known to cause liver toxicity in some patients; and, Singular has infrequent and mild side effects.

Aspen Rehab Technique

Aspen’s cutting-edge non-surgical option is non-invasive and can be done in-office. This therapeutic technique is successful in the treatment of Grade II and III, as well as some cases of grade IV, Capsular Contracture. Research on the Aspen protocol shows that 90% of patients achieve improvement to a within normal limit softness and shape. With the power of sound waves, this non-surgical therapy method increases the blood flow around the breast implant resulting in the softening of the capsule.

Each patient will receive ten treatments of the Aspen Rehab Technique. This method is effective and efficient in the treatment of this complication. The rate of recurrence is reduced as well with Aspen’s Rehab Protocol.

Before & After

Most Effective Treatment for Capsular Contracture

Aspen After Surgery, a post-plastic surgery treatment facility located in Coral Springs, Florida, that specializes in the most effective non-surgical method for capsular contracture. The Aspen Rehab Technique has been carefully researched and patented to provide a treatment for Capsular Contracture that is both non-invasive and successful. By utilizing the Aspen Protocol, the shape, softness, and symmetry of the breast are restored following Capsular Contracture.

Singulair Side Effects

Singulair, also known as montelukast, is a medication commonly prescribed to treat asthma and allergies. While it is generally well-tolerated by most patients, there are potential side effects that individuals should be aware of before starting treatment. These side effects can range from mild to severe and may vary from person to person.

One common side effect of Singulair is headache. Some patients may experience mild to moderate headaches while taking this medication. This side effect typically resolves on its own and does not require medical intervention. However, if the headaches become severe or persistent, it is important to consult with a healthcare provider.

Another potential side effect of Singulair is gastrointestinal issues. Some patients may experience stomach pain, nausea, diarrhea, or indigestion while taking this medication. These symptoms are usually mild and temporary, but if they persist or worsen, it is important to seek medical advice.

In rare cases, Singulair can cause more serious side effects such as mood changes, depression, or suicidal thoughts. It is important to monitor for any changes in mood or behavior while taking this medication and to seek immediate medical attention if any concerning symptoms arise.

Other potential side effects of Singulair include:

– Fatigue
– Dizziness
– Rash
– Muscle aches
– Increased liver enzymes

It is important to note that not everyone will experience these side effects while taking Singulair. The benefits of this medication often outweigh the potential risks, and many patients find it to be an effective treatment for their asthma or allergies.

In conclusion, while Singulair is generally a safe and effective medication for the treatment of asthma and allergies, it is important to be aware of the potential side effects associated with this drug. Patients should discuss any concerns or questions with their healthcare provider before starting treatment with Singulair.

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