Going off-label with breast implants

Off-label use of contrast agents

When contrast agents are approved, the label describes the approved indications and particular circumstances of use such as age, organ function or pregnancy. The use of contrast agents outside their labelled indications is increasing, namely with contrast agents used for MRI. The aim of this paper is to improve the knowledge about this topic. The basis for off-label use is the physician's prerogative, which finds its basis in the "Declaration of Helsinki". Off-label use is allowed under special conditions and might be even the medical state of the art. The necessity for off-label use will continue to increase for MR-contrast agents, as the regulatory requirements for approval of new indications continuously increase, and clinical trials for registration purposes are quite costly and time consuming. As a consequence, manufacturers will concentrate on clinical studies for the essential indications.

Transumbilical breast augmentation is safe and effective

Transumbilical breast augmentation (TUBA) has proved to be safe and effective. This article highlights the advantages, disadvantages, gives an overview of the technique, discusses complications, and provides factual information to counter false negative information about the procedure.

The effects of zafirlukast on capsular contracture: preliminary report

Capsular contracture after breast augmentation is a distressing, troublesome event both for the patient and the surgeon. Fibrosis transforms the prosthesis into a hardened sphere, turning the initially satisfactory cosmetic result into a deformed mass. Treatment for capsular contracture can be either surgical, consisting of capsulotomy or capsulectomy with implant replacement, or pharmacologic, consisting of intracapsular instillation of steroids and antibiotics. The success rates for both types of treatment vary. Although capsular contracture is a multifactorial process, one common denominator in the successful treatment of this complication is believed to be the abatement of inflammation. Leukotriene antagonists have emerged recently as effective prophylactic agents for reactive airway diseases. Anecdotal reports have indicated that zafirlukast and montelukast effectively reverse capsular contracture. The authors investigated whether capsular contracture varies significantly over time after zafirlukast therapy by studying 20 women who had breast prostheses implanted and then experienced the development of capsular contracture. The results suggest that capsular contracture responds favorably to treatment with zafirlukast. The findings indicate that zafirlukast may reduce pain and breast capsule distortion for patients with long-standing contracture who either are not surgical candidates or do not wish to undergo surgery.