Non-surgical Treatment and Prophylaxis of Capsular Contracture in Mammary Implants: A Systematic Review of Literature.

backgroundCapsular contracture is the most frequent reason for reoperation after implant-based breast surgery. Evaluate non-surgical treatment options for capsular contracture and to ascertain whether the long-term progression of capsular contracture is inhibited by the prophylactic administration of specific medications.

methodsA review of articles published in Pubmed, SciELO Cochrane, LILACS and Web of Science was carried out. The crossings followed the requirements of each base, in which the controlled descriptors used were: "Capsular contracture," "Prophylaxis" and "Treatment".

results1732 articles were found and 19 articles that met the inclusion and exclusion criteria were included. Leukotriene inhibitors play a role in the adhesion of lipoxygenases, in a similar way to non-steroidal anti-inflammatory drugs (10 mg/kg for montelukast and 1.25 mg/kg for zafirlukast). Tamoxifen (75 mg) treatment in the mouse silicone breast implant model produced capsule formation through modulation of myofibroblasts. Other medications such as Roxatidine, which plays an important role in preventing fibrosis by inhibiting NF-κB activation, and beta blockers (10 mg/kg orally once daily) can reduce capsular contracture.

conclusionCapsular contracture in initial stages (I-II) may have a clinical treatment and prophylaxis. Some medications studied to prophylaxis and treatment of capsular contracture are leukotriene inhibitors, tamoxifen, angiotensin-converting enzyme inhibitors, beta-blockers, pirfenidone and botulinum toxin. LEVEL OF EVIDENCE IV: 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 .