The Role of Montelukast in the Prevention and Treatment of Capsular Contracture (Baker Grade III–IV) - A Systematic Review and Case Analysis

INTRODUCTION: Capsular contracture remains a significant challenge in breast implant surgery. Recent research has focused on the role of inflammatory mediators, particularly leukotrienes. The aim of this article was to conduct a systematic review of existing clinical data on an orally active selective leukotriene receptor antagonist (montelukast) and capsular contracture management in combination with surgery and to present some representative cases. MATERIALS AND METHODS: A meta-analysis was performed with the following keywords: "Montelukast," "Singulair," "capsular contracture," "Baker grade," and "breast implants." References from identified articles were screened to capture additional studies not retrieved through database searches (PubMed and Semantic Scholar). Moreover, we provided representative case samples in patients with Baker Grade III-IV capsular contracture undergoing surgical treatment with adjuvant montelukast treatment once daily for 90 days. RESULTS: Five studies with 1343 patients were included. Prophylactic montelukast reduced capsular contracture rates, particularly in Baker grade I-II cases, with statistical significance in two studies. In Baker grade III-IV contracture, montelukast had limited effect, and most patients required surgery. Extended therapy downgraded some severe cases to Baker grade II. In line with the current literature, our case examples confirmed the efficacy of montelukast with minimal side effects. CONCLUSION: By synthesizing available evidence, the potential of leukotriene receptor antagonism as a therapeutic adjunct to surgery for the treatment of capsular contracture is promising. The findings could pave the way for new treatment paradigms in breast implant surgery, potentially improving outcomes and patient satisfaction. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .