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

Abstract

Sir: Breast augmentation is one of the most common aesthetic operations performed in recent years, and capsular contracture continues to be one of the most concerning complications regarding this procedure. As a result, studies on this topic keep progressing, aiming to reduce the capsular contracture rate after surgery. With great respect and appreciation, we read the recently published article entitled “The Effect of Omega-3 Fatty Acids on Capsular Tissue around the Breast Implants,” by Lombardo et al. in Plastic and Reconstructive Surgery.1 By presenting a well-designed experiment, the authors concluded that dietary omega-3 supplementation can effectively reduce the occurrence of capsular formation, thus possibly reducing the capsular contracture rate after breast augmentation. In this communication, we raise several questions regarding this experiment, hoping to benefit future studies. First, the omega-3 dose fed to the mice was 300 mg/kg in this experiment. However, we failed to find detailed information about why this dosage was used and whether it was the optimal dosage in mice. Usually, a preliminary experiment is required to determine the optimal dosage and best time before the formal experiment. We look forward to further evidence supporting the dose-effect and time-effect curves of omega-3. Second, as published evidence and expert opinion reveal, the pathogenesis of capsular contracture is thought to be multifactorial, including the surface of breast implants, the plane of implant placement, the incision of the procedure, and the patient’s history of radiotherapy. Although it is well-known that use of smooth implants leads to a higher rate of capsular contracture postoperatively, textured surface implants can also cause this type of complication. With textured implants widely used in Europe and Australia (approximately 90 percent textured and 10 percent smooth),2 the prevention of capsular contracture after textured implant placement continues to be of great concern. In this experiment, only round, smooth, silicone gel implants were used; thus, the effect of omega-3 fatty acids on capsular tissue around the textured/microtextured surface breast implants remains uncertain. This could be one of the aspects of further study. Third, 12-week postoperative capsule thickness was used as a main observation index in this experiment. However, how the capsule thickness is relevant to the occurrence rate of capsular contracture was not well-explained in this article. To our knowledge, no evidence shows that the occurrence of capsular contracture is directly related to the thickness of the capsule; however, the study shows that the orientation and organization of the collagen fibers appear to change when capsular contracture occurs: the fibers become thicker and establish themselves in cable-like bundles that orientate themselves perpendicular to the fibroblasts to produce a helical orientation as the severity increases.3 Thus, we question the necessary correlation between the capsule thickness and the occurrence of capsular contracture. We believe an improved indicator may better match the directivity to capsular contracture, thus increasing its clinical reference value in further studies. DISCLOSURE The authors have no financial interest to declare in relation to the content of this study. No funding was received for this communication.