Montelukast vs Tranilast Administration in the Prevention of Capsular Contracture in Alloplastic Breast Surgeries: An Experimental Mice Model.

Background: Capsular contracture remains a prevalent complication following breast implant augmentation. Despite growing interest in pharmacological prevention, optimal drug selection and administration timing remain unclear.

Objectives: The authors of this study aim to compare the efficacy of tranilast vs montelukast and evaluate prophylactic vs postoperative administration in preventing capsular contracture.

Methods: Eighty male C57BL/6J mice were randomized into 5 groups: control, post-montelukast, pre-montelukast, post-tranilast, and pre-tranilast. For 1 preoperative month, the control group received daily saline (1 mL) through gavage, whereas drug-treated groups received montelukast (10 mg/kg/day) or tranilast (50 mg/kg/day). Prophylactic groups initiated drug administration preoperatively. Miniature implants were bilaterally placed dorsally, followed by 3 months of postoperative drug continuation. Histopathological evaluation assessed capsule thickness, macrophage infiltration, collagen density, and inflammatory response.

Results: At 90 days post surgery, all drug interventions significantly reduced capsular thickness compared with the control group (control: 232.4 ± 43 μm; post-montelukast: 137.5 ± 24 μm; pre-montelukast: 107.7 ± 20 μm; post-tranilast: 93.3 ± 22 μm; pre-tranilast: 70.2 ± 11 μm; P < .0001). The pre-tranilast group demonstrated the lowest collagen deposition at 90 days (16.0 ± 5% vs control: 76.6 ± 13%; P < .001). Pre-tranilast exhibited superior macrophage inhibitory effects compared with post-tranilast administration. Furthermore, tranilast outperformed montelukast in efficacy regardless of administration timing.

Conclusions: Prophylactic tranilast administration significantly attenuates capsular contracture by reducing inflammation, macrophage infiltration, and collagen deposition, surpassing both postoperative tranilast and montelukast. These findings support prioritizing preoperative tranilast in clinical trials to improve breast implant outcomes.