Suppressive Effect of Leukotriene Antagonists on Capsular Contracture in Patients Who Underwent Breast Surgery with Prosthesis: A Meta-Analysis.

[BACKGROUND] Capsular contracture is a troublesome and distressing complication in mammaplasty or breast reconstruction involving a prosthesis. Previous studies have indicated that leukotriene antagonists effectively reverse capsular contracture. However, this treatment method lacks comprehensive support from evidence-based medicine and remains considerably controversial. In this study, a meta-analysis was conducted to evaluate the therapeutic and preventive effects of leukotriene antagonists on capsular contracture in patients after breast prosthesis implantation.

[METHODS] A comprehensive literature search was performed in English and Chinese databases. All clinical studies assessing the therapeutic and prophylactic effects of leukotriene antagonists on capsule contracture after breast prosthesis implantation were selected. Risk differences and 95 percent confidence intervals were applied as the final pooled statistics.

[RESULTS] A total of five eligible studies were included, involving 1710 breast prosthesis implantations. The final results indicated that leukotriene antagonists markedly inhibited capsular contracture formation, with statistical significance at 32.02 (p < 0.001) (pooled risk difference, 0.84; 95 percent CI, 0.79 to 0.89). In subgroup analysis, subgroups based on different leukotriene antagonists included the montelukast and zafirlukast groups, with significant pooled statistical levels of 19.34 (p < 0.001) and 79.48 (p < 0.001), respectively (montelukast: pooled risk difference, 0.83; 95 percent CI, 0.75 to 0.92; zafirlukast: pooled risk difference, 0.85; 95 percent CI, 0.83 to 0.87), indicating that both montelukast and zafirlukast were effective in inhibiting encapsulation.

[CONCLUSIONS] This meta-analysis demonstrated that leukotriene antagonists (montelukast and zafirlukast) have significant effects in treating and preventing capsular contracture. These medications should be administered in a reasonable and safe way. Further studies of clinical efficacy, duration, safety, and exact mechanism of leukotriene antagonists for periprosthetic capsular contracture are warranted.