LAUSR

Sir, With great interest, we read the article titled ‘‘In Vivo and In Vitro Fibroblasts’ Behavior and Capsular Formation in Correlation with Smooth and Textured Silicone Surfaces’’ by Huang et al [1]. Breast augmentation and breast reconstruction with the use of silicone implants are the most commonly performed Plastic Surgery procedures in the USA. Capsular contraction is the most common longterm complication following silicone-based breast surgery, which is occurred up to 30% of cosmetic and up to 70% of reconstructive patients after radiation therapy [2, 3]. Although the incidence of capsular contraction is relatively high, to the best of our knowledge there is scarcity in the literature to articles investigated the basic science aspect of the problem. Direct immunostimulation and subclinical infection are suggested as the main mechanisms for the induction and the evolution of capsular contracture. Thus, papers like the above which investigate subject of the biocompatibility of the breast implants are more than welcomed, and even necessary in the scientific domain and clinical practice for safety reasons. The authors implanted breast implants from three different categories. As a result, they were able to investigate not only the differences in body reaction between the two broad categories of breast implants (smooth vs texture), but also any differences between texture implants of varying thickness/morphology. The authors also investigated the effects of surface topography, surface roughness, and contact angle on fibroblast adhesions/morphologies and cytoskeletal organization. In general, animal studies lack non-invasive in vivo assessments of capsule formation and, as a result, objective methods of studying contracture. Therefore, by adding all the above-mentioned parameters the authors were able to provide non-invasive in vivo measurements of the impact of implant surface properties on capsule formation using the rat model. According to the authors, surface roughness has been linked to changes in the biological behavior of fibroblasts and capsular formation. Textured surfaces were more hydrophobic than smooth surfaces. The authors concluded that the number of myofibroblasts may contribute more to the process of capsular contracture than capsular thickness. So, the authors proposed that myofibroblasts should be the target for capsular contraction prevention. The authors also suggested that the capsule thickness is not significantly correlated with the capsular contracture. There is no agreement in the literature on the effect of implant surface properties on capsule formation. Although most of the studies suggested fibrous tissue deposition is negatively affected following textured implants, there are significant differences compared to smooth implants [4]. On the other hand, the study’s length of follow-up period (6 weeks) was insufficient for determining whether the study’s findings were affected by time. Fischer et al. demonstrated, using the rat model, that textured implants resulted in a comparable mid-term (60 days) peak in capsule thickness. Moreover, although textured implants lead to temporarily thicker, but less dense capsules compared to & Petros Konofaos [email protected]