Reply: The Effect of Omega-3 Fatty Acids on Capsular Tissue around the Breast Implants.

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Sir: We appreciate Dr. Zhang’s interest in our article entitled “The Effect of Omega-3 Fatty Acids on Capsular Tissue around the Breast Implants.”1 Our experimental model was approved by the local institutional ethics committee and was performed in agreement with Italian legislative decree. We used an existing capsular contracture model on mice,2 customizing it for our purpose and using a dosage of omega-3 fatty acid previously described.3 I agree with Dr. Zhang that further clinical studies are mandatory to evaluate the right dosage of omega-3 to apply to human dietary regimens. Concerning breast implant surface, there are no studies with a high level of evidence showing a greater risk of capsular contracture in smooth implants compared to textured implants. Smooth implants were used especially in the past when dual-plane technique was not described yet, and most of them were positioned in a subglandular plane, thus leading to a higher risk of contamination and capsular contracture. After the breast implant-associated anaplastic large cell lymphoma scandal, the use of smooth implants has become increasingly common, especially in cosmetic procedures. The best method to evaluate capsular contracture is clinical assessment using the Baker score. According to Dr. Zhang,4 there is no correlation between capsular thickness and capsular contracture. The authors in this study correlated the presence of the mast cells in the capsular contracture.4 Unfortunately, this field has few studies with a high level of evidence. In the medical literature, we found the classification introduced by Wilflingseder et al. as the most commonly used score. It reflects exactly the clinical and morphologic conditions that can be graded using four categories.5 Prantl et al. clarified the relationship between clinical and histologic alterations in patients with capsular contracture comparing Baker grade to Wilflingseder grade. There was a positive correlation between capsular thickness and Baker grade, and between the clinical assessment (Baker grade I to IV) and the histologic classification (Wilflingseder grade I to IV).6 DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication.