Effects of Zafirlukast on the Capsular Fibrosis of Silicone Breast Implants

Abstract

Emre Hocaoglu, Tamer Koldas, Baris Keklik, Ahmet Bicer, Ozgur Mete, Halim Issever

Objective: Capsular contracture is the most common complication reported after breast augmentation. Recent studies have established the role of leukotriene receptors in capsular contracture formation. Zafirlukast is a leukotriene receptor antagonist, and its effects on experimental models of periprosthetic capsular fibrosis have been shown to decrease capsule thickness and reduce factors that are directly and indirectly involved in capsular contracture. The goal of this study was to improve the periprosthetic capsular formation model in rats and demonstrate the effects of oral Zafirlukast administration on capsular fibrosis. Methods: Forty-eight adult female Sprague-Dawley rats were divided into four groups. Smooth-surfaced, gel-filled prostheses were implanted in 36 rats. Group A: The day of the operation, 12 animals received Zafirlukast treatment for 14 weeks (oral gavage, once a day, 6 days a week, 4 mg/kg/day); Group B: 10 weeks after the operation, 12 animals received Zafirlukast treatment for 4 weeks; Group C: 12 animals were implanted but did not receive treatment; Group D: 12 animals did not have an operation, but for 14 weeks received oral gavage containing water instead of Zafirlukast. At the end of the 14 weeks, the implants with the surrounding capsules were extracted. Blind macroscopic inspectional evaluation of the capsules was performed, and microscopic capsular thickness measurements were made. Results: The mean capsular thickness was 0.033 mm (SD: 0.011) in Group A, and 0.089 mm (SD: 0.023) and 0.125 mm (SD: 0.025) in Groups B and C, respectively. Differences between Groups A and C and between Groups A and B were significant (p0.05). Similarly, Macroscopic Inspectional Fibrosis Scoring showed a significant difference between Groups A and C and a non-significant difference between Groups B and C. Conclusion: Daily prophylactic oral administration of Zafirlukast immediately after implantation significantly diminishes the development of fibrotic capsules around the silicone prostheses.