BACKGROUND:Because the breast is one of the target organs of estrogen and progesterone, it is confirmed to have periodic changes through the menstrual cycle. Several studies reported that surgeries on the breast could be influenced by the menstrual cycle, which remained controversial. OBJECTIVES:The aim of the authors of this study is to determine whether the menstrual cycle affects breast reduction surgery. METHODS:Patients undergoing breast reduction from 2004 to 2021 were reviewed. They were grouped according to different menstrual phases in a standard 28-day cycle: proliferative (Days 3-7), follicular phase of differentiation (Days 8-14), luteal phase of differentiation (Days 15-20), secretory (Days 12-27), and menstrual (Days 28-2). Their length of surgery, drainage after operation, drainage duration, and incidence of hematoma were recorded and analyzed. RESULTS:The study on 722 patients demonstrated that there was no statistical difference in the length of operation and postoperative drainage when performing operations on different menstrual phases. CONCLUSIONS:For patients having breast reduction surgery, their menstrual cycle had no influence on the length of surgery and postoperative drainage, whereas further studies were needed. LEVEL OF EVIDENCE: 3 (THERAPEUTIC):

Background: This study aimed to explore the application value of magnetic resonance imaging (MRI)-based three-dimensional segmentation and reconstruction technology for spatial structural identification and volumetric quantification of glandular and adipose tissues in bilateral gynecomastia (GM) patients undergoing surgical treatment, hoping to provide precise imaging data to support clinical surgical decision-making. Methods: A retrospective analysis was performed on preoperative MRI images and general clinical data of 52 patients with bilateral gynecomastia at the patient level (bilateral totals, N = 52) who underwent surgical treatment in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, from March 2023 to September 2024. All images were acquired using a SIEMENS Aera 1.5 T MRI scanner with T1-weighted three-dimensional fat-suppressed sequence (t1_fl3d_tra_spair). Semi-automatic segmentation and active contour modeling (Snake model) using ITK-SNAP 4.0 software were employed to independently identify glandular and adipose tissues, reconstruct accurate three-dimensional anatomical models, and quantitatively analyze tissue volumes. Results: The MRI-based three-dimensional segmentation and reconstruction method accurately distinguished glandular and adipose tissues in male breasts, establishing precise three-dimensional anatomical models with excellent reproducibility and operational consistency. Among the 52 patients with bilateral gynecomastia, glandular tissue volume exhibited a markedly non-normal distribution, with a median of 6.11 cm3 (IQR, 3.03–12.98 cm3). Adipose tissue volume followed a normal distribution with a mean of 1348.84 ± 494.97 cm3. The total breast tissue volume also showed a normal distribution, with a mean of 1361.97 ± 496.83 cm3. The proportion of glandular tissue in total breast volume was non-normally distributed with a median of 0.50% (IQR, 0.27–1.21%), while the proportion of adipose tissue was also non-normally distributed with a median of 99.50% (IQR, 98.79–99.73%). Conclusions: MRI combined with computer-assisted three-dimensional segmentation and reconstruction technology efficiently and accurately achieves spatial identification, three-dimensional modeling, and volumetric quantification of glandular and adipose tissues in patients with bilateral gynecomastia. It objectively reveals the spatial compositional characteristics of male breast tissues. This approach provides precise, quantitative data for clinical decision-making regarding surgical treatment of gynecomastia, featuring robust standardization and strong clinical applicability.

BACKGROUND:Oil cyst formation is a common complication following autologous fat grafting (AFG) for breast augmentation. Despite various fat processing techniques, no consensus exists on the optimal method to mitigate this complication. The authors introduce an innovative fat processing approach, the ultrafiltration adsorption technique, designed to prevent postoperative breast oil cysts in large-volume AFG for breast augmentation. This study aimed to evaluate the clinical efficacy of this technique. METHODS:A retrospective study was conducted on 116 patients who underwent primary aesthetic AFG breast augmentation with the final purified fat tissue. Demographic data, operative details, and postoperative outcomes were analyzed. RESULTS:The mean patient age was 34 ± 4 years, and the mean body mass index was 20.19 ± 1.39 kg/m 2 . The average fat volume injected per breast was 210.00 mL ± 39.00 mL. During the 3 to 12 months of follow-up, no palpable nodules were observed in any patients, and ultrasound imaging confirmed that there were no cysts in aesthetic patients. Among 20 aesthetic patients (40 breasts), the average postoperative breast volume retention rate was 67.28%. CONCLUSIONS:The ultrafiltration adsorption technique is an effective fat processing method. It significantly reduces the formation of oil cysts and improves volume retention rates in large-volume AFG breast augmentation.

BACKGROUND We propose a hybrid breast augmentation (HBA) method combining implants and fat grafting and explore the outcome and safety through a retrospective, single-center, propensity score-matched (PSM) comparative study. METHOD Outcome, satisfaction, and complications were compared between the HBA group (302 cases) and the implant-based breast augmentation (IBA) group (353 cases), the HBA group and the autologous fat grafting (AFG) group (277 cases). RESULT The mean follow-up period was 31.7 months. After PSM, 270 cases were matched between the HBA and IBA groups, and 156 cases were matched between the HBA and AFG groups. Compared to the IBA group: HBA achieved higher scores of implant visibility/palpability and upper pole contour with the specialists' evaluations (before and after PSM, P<0.05). Regarding patient satisfaction, the scores of softness (before and after PSM), smoothness of the upper pole (before PSM), and overall satisfaction (after PSM) of the HBA group were better (P<0.05). Implant-related complications occurred at a similar rate. Compared to the AFG group: HBA achieved higher scores of shape (before and after PSM) and symmetry (after PSM) with evaluations of specialists (P<0.05). The scores of shape, symmetry and overall satisfaction in the HBA group were better (before and after PSM, P<0.05). The HBA group showed a lower incidence of palpable cysts, fat necrosis, oil cysts, and fat calcification (before PSM, P<0.05). CONCLUSION By comparing the three techniques objectively, HBA presented better indices of aesthetic outcomes, satisfaction and acceptable complications rates when compared to IBA and AFG.

Endoscopic-assisted transaxillary breast augmentation allows performing Pecs block under direct visualization. This study aimed to describe this new technique and demonstrat its short-term efficacy and safety with a preliminary clinical study. Patients enrolled for transaxillary endoscopic-assisted prosthetic breast augmentation between February 2022 and March 2023 in two medical centers were included in the pectoral nerve block group. Postoperative VAS scores at 1, 4, 12, 24, 48, and 72 h, surgery duration, and the occurrence of nausea and vomiting were compared with a historical cohort of patients collected between February 2021 and January 2022 with the same inclusion criteria. 229 patients were included in the Pecs group and 116 patients were identified in the control group. No statistical difference was observed in patient characteristics. VAS score at postoperative 1 h and 72 h was similar between the two groups, whereas VAS score at postoperative 4 h, 12 h, 24 h and 48 h in Pecs group was significantly lower than control group. The occurrence of PONV in the Pecs group is significantly lower than in the control group. The duration of surgery is similar between the two groups. No block-related complication was observed in the Pecs group. A novel approach by combining pectoral nerve blocks with transaxillary endoscopic-assisted breast augmentation to perform blocks under direct vision was proposed and its short-term efficacy and safety was determined by this study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background Abdominal contouring through liposuction has been practiced for decades. However, few studies have focused on describing the definition and enhancement of the waistline in torso contouring procedures. Objectives In the present study, the authors proposed a waistline-based strategy for abdominal liposculpture to achieve a better aesthetic outcome and emphasize high overall patient satisfaction. Methods The data of patients who underwent the waistline-based liposculpture procedure from 2020 to 2023 were retrospectively reviewed. Aesthetic improvement of the central trunk contour was evaluated and analyzed by comparing preoperative and postoperative photogrammetric measurements. Satisfaction with the outcome was assessed with a patient satisfaction questionnaire. Results A total of 70 patients were enrolled in this study. During 6 months of postoperative evaluation, the shape of the central trunk contour improved significantly (both waist concavity and hip convexity increased quantitatively, P < .05), while the position of the waist did not differ significantly postoperatively (P > .05). All patients were satisfied with their postoperative outcomes, including their overall aesthetic appearance, waistline position, and waist-to-hip ratio. There were no intraoperative complications or rare postoperative complications. Conclusions Waistline-based liposculpture is a simple and effective procedure to improve the aesthetic outcomes of trunk contouring and has highly satisfactory results after long-term follow-up. Level of Evidence: 5

BACKGROUND:High mobile glandular ptotic breasts present the greatest challenge for implant breast augmentation with suboptimal outcomes occurring frequently. Here, we describe and evaluate an innovative approach for breast augmentation in this breast type. By widely disrupting and redefining the parenchyma-muscle interface, this technique offers opportunities to restore the takeoff point of the breast and improve the fullness of the upper pole, thus producing a "perkier" breast appearance. METHODS:A retrospective review was performed, and 68 patients who underwent breast augmentation with either type III dual-plane or the new approach between January 2015 and January 2021 were included. The patients were divided into two groups. The aesthetic outcome and patient satisfaction were evaluated using different 10-point rating forms. Data on demographic information, surgical details, and relative complication rates were recorded and compared. RESULTS:Upon comparing the aesthetic outcomes and satisfaction, the test group demonstrated better breast shape, nipple-areola position, upper pole contour outcome, and upper pole satisfaction. No post-operative hematoma, seroma, or infection occurred in either groups. No double-bubble deformity occurred in the test group, whereas it occurred in two patients in the control group. The rates of capsular contracture were 1.4% and 1.6%, in the test and control groups, respectively. CONCLUSIONS:The new approach is a safe surgical method with good aesthetic outcome, high patient satisfaction, and long-lasting result. This approach is a supplement to the dual-plane techniques, to realize the benefits of mastopexy and type III dual-plane breast augmentation.

Objective:To preliminarily evaluate the outcome of fat grafting breast augmentation using filtration-adsorption technique.Methods:Patients undergoing autologous fat grafting (AFG) breast augmentation between July of 2020 and March of 2021 were retrospectively reviewed at Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College. Patients with complete data who followed up for at least 3 months were included. The lipoaspirates were processed with filtration-adsorption technique and AFG breast augmentation were performed (filtration-adsorption group), and then sedimentation method which was commonly used clinically was set as the control group (sedimentation group). During the follow-up, breast palpation and ultrasound inspection were performed, and the breast volumetric change between preoperative and postoperative was quantitatively compared by three-dimensional scanning technique. Demographic and surgical details were statistically analyzed. Postoperative breast volume retention rates and complication rates were calculated and compared. Normally distributed continuous variables were described in the form Mean±SD, and t-test was used for analysis. Non-normal distributed continuous variables were described in the form of M ( Q1, Q3) and analyzed by Mann-Whitney U test. The classified data were analyzed by Fisher exact probability test. Results:A total of 20 female patients (40 breasts) were included, including 10 patients (20 breasts) aged (31.4±2.5) years in sedimentation group and 10 patients (20 breasts) aged (28.5±4.4) years in the filtration-adsorption group. The fat injection volume in the filtration-adsorption group was 151.1 (125.0, 175.0) ml, and 165.0 (151.3, 196.3) ml in sedimentation group, respectively, with no statistical significance ( P>0.05). The breast volume retention rate in filtration-adsorption group was (62.93±14.06)%, which was significantly higher than that in sedimentation group (24.97±11.02)% ( P<0.01). During postoperative breast ultrasound examination, 2 breasts in sedimentation group had palpable nodules (< 6 mm), 1 breast had ultrasonically detectable but clinically inaccessible nodules (< 4 mm), while only 1 breast in the filtration-adsorption group had an oil cyst (4 mm×2 mm). The complication rate in the filtration-adsorption group was lower than that in sedimentation group[5.0%(1/20) vs. 15.0%(3/20), P>0.05]. Conclusion:The filtration-adsorption technique is an ideal method for fat grafting, which would multiply the volume retention rate in large-volume AFG breast augmentation and reduce the rate of complications.

Implant-based breast augmentation remains popular, but the controversy over the safety and longevity of implants has continued. An event-based analysis of reasons for implant explantation may provide us with some insight into the controversy. Data from May 1994 to October 2022 of explantation cases from aesthetic breast augmentation in three medical centers were retrospectively reviewed. Patient characteristics, time to explantation, reasons for visit, the major reason for explantation and intraoperative findings were analyzed. A total of 522 patients with 1004 breasts were included in our study. Objective explantation reasons accounted for 34.0 www.springer.com/00266 .

Background Breast hypertrophy causes physical and psychological symptoms. Reduction mammaplasty is a surgical procedure to lessen discomfort. However, there is a dispute about whether the weight of breast resection is related to body weight. This study aims to provide Chinese data and assess the association between body weight and removed weight in women undergoing reduction mammaplasty. Methods Retrospective data were collected from 1777 breasts in a single center in 17 years. Simple linear regression analysis was performed to establish whether removed weight and removed weight ratio (removed weight/body weight) correlated with the body weight. The correlations were then analyzed again after grouping according to the removed weight. Results For all breasts included, removed weight or ratio positively correlates with body weight. When the removed weight is more than 1000g, there is no statistically significant correlation between body weight and removed breast weight. When removed per breast weight is more than 600g, there is no correlation between body weight and removed breast weight ratio. Conclusions The correlation between body weight and removed weight or ratio decreased with increasing removed weight. When removed weight >600g, the degree of breast hypertrophy is not related to body shape. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Therapeutic study.

Objective This study aimed to investigate the effects of surgical timing, procedure, and age, on complication rates, health-related quality of life, and postoperative satisfaction, in patients who underwent breast reconstruction. Methods The data of 80 patients who underwent breast reconstruction surgery between August 2004 and June 2018 were reviewed. Patients were grouped according to surgical timing, procedure, and age. The evaluation indicators included complications and BREAST-Q scores. The statistical methods used included the Mann-Whitney U test and analyses of variance and covariance. Results The incidence of complications was 15.0% (12/80). The complication rates were similar in each group (P > 0.05). The postsurgical scores of patient satisfaction with breast, psychosocial well-being, and sexual well-being were higher than the presurgical scores (P < 0.05). The postoperative psychosocial and sexual well-being scores of patients in the immediate group were higher than those in the delayed group (P < 0.05). The satisfaction with the outcome in the abdominal flap group was higher than that in the other group, whereas the sexual well-being score of the abdominal flap group was lower than that of the other group (P < 0.05). The scores of the postoperative physical well-being of the chest and abdomen in the younger group were higher than that in the older group (P < 0.05). Conclusions Breast reconstruction can significantly improve patients' health-related quality of life and satisfaction. Immediate breast reconstruction can reduce the adverse psychological and physical effects that breast loss exerts on patients, leading to better postoperative satisfaction. Patients who underwent breast reconstruction with abdominal flaps had higher postoperative satisfaction. Breast reconstruction in elderly patients was associated with considerable postoperative satisfaction.

Breast implants are widely used in breast plastic surgery. Capsular contracture after breast implant surgeries remains as a common complication and difficult to solve, which is often related to the success or failure of the operations. Therefore, how to prevent capsular contracture after prosthesis implantation has always been a hot issue in breast plastic surgery. The exploration of the causes of capsular contracture has never stopped, but its etiology has not been fully clarified. Subclinical infection may be one of the important causes of capsular contracture. To prevent the occurrence of subclinical infection, many method have been used. Among them, pocket irrigation is considered as an effective way in preventing bacterial adhesion, thus preventing the occurrence of subclinical infection, and finally preventing capsule contracture. However, many kinds of antibacterial irrigation can be used in clinics. There is still a lack of consensus on which irrigation solution has the optimal effect. This paper analyzes and summarizes the status of application regarding antibacterial irrigation solution in breast prosthesis implantation, to provide suggestion for its clinical application.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.

The safety of banked human adipose-derived stem cells (hADSCs) purified by 155 mM ammonium chloride (NH4Cl)-based erythrocyte lysis has not been evaluated. This study was conducted to determine the impact of NH4Cl-based erythrocyte lysis on the biological characteristics of cryopreserved hADSCs. Stromal vascular fractions (SVFs) were obtained from lipoaspirates and purified with NH4Cl-based erythrocyte lysis (lysis group) or without (nonlysis group). The hADSCs were freshly isolated (fresh group) from SVFs and/or cryopreserved for 2 weeks (cryo group). The morphologies, immunophenotypes, viability, apoptosis, and growth kinetics of each group were compared. The cell cycle and differentiation capacity assays were performed in both cryopreserved groups. All groups showed similar cell morphology, immunological phenotypes, and viability. However, the main effect of lysis and its interaction with cryopreservation were observed when early apoptosis was regarded as a dependent variable in two-way repeated-measures analysis of variance. After cryopreservation, significant growth retardation and S-phase fraction reduction were observed in lytic hADSCs compared with those in nonlytic hADSCs. No significant differences in the adipogenic and osteogenic differentiation capacities were found between the two groups. Although NH4Cl-based erythrocyte lysis did not affect the cell morphology, immunological phenotypes, viability, and adipogenic and osteogenic differentiation capacities of cryopreserved hADSCs, exposure to NH4Cl-based erythrocyte lysis or its synergistic action with cryopreservation may induce apoptosis and inhibit the proliferation and mitosis of cryopreserved hADSCs. These results indicate that NH4Cl-based erythrocyte lysis is not suitable for high-quality banked collection of hADSCs for future clinical applications. Further development of safe, convenient, and cost-effective purification methods of hADSCs is warranted.

See the Original Article here. It was a pleasure to review the article “Efficacy of Tranexamic Acid (TXA) in Reducing Seroma and Hematoma Formation Following Reduction Mammaplasty.” 1 The study is a retrospective review of 385 consecutive patients who experienced bilateral reduction mammaplasty. Topical TXA was utilized in 66.8% of the cases, and intravenous TXA was utilized in 33.1% of the cases. The authors should be commended for publishing the largest study on the utilization of intravenous and topical TXA. They concluded the utilization of drains significantly reduced the risk of seroma and stated there was no reduction in risk when utilizing TXA in breast reduction surgery. Essentially, the authors concluded that there was no benefit of utilizing either intravenous or topical TXA. This finding is quite interesting considering other articles have revealed a trend towards decrease in drainage output. Ausin et al found median fluid output decreased 42%...

To evaluate the analgesic effect of pectoral nerve block in implant-based mammoplasty. EMbase, PubMed, Web of science, MEDLINE, CNKI, Wanfang Database, VIP and other databases were searched from establishment to February 2022 by computer to collect randomized controlled trials which applied pectoral nerve block in implant-based mammoplasty, and meta-analysis was conducted after data extraction and quality evaluation of the literature meeting the inclusion criteria. A total of 336 patients in seven RCT studies were included in this study. Pectoral nerve block has a significant effect on postoperative analgesia in patients with implant-based mammoplasty with 1h VAS score significantly reduced in the resting state (MD=−1.85, 95 www.springer.com/00266 .

假体隆胸手术能够为患者带来理想的美容效果,但术后常会出现不同程度的疼痛,给整形医师及患者带来较大困扰.随着临床实践的不断发展,神经阻滞、假体腔隙灌洗、肉毒素胸大肌注射等方法为假体隆胸术后局部镇痛提供了新思路.单一的镇痛方法由于自身的局限性限制了其在临床的推广应用,而多种局部镇痛方法的联合应用可以提供更全面、安全、长效的镇痛方案,以优化假体隆胸术后疼痛管理,为未来假体隆胸术后疼痛的治疗提供帮助.

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.

www.PRSJournal.com 901 In reconstructive and plastic surgery, breast surgery with prosthetic implants is a common procedure. Periprosthetic capsular contracture is one of the most troublesome and frequent complications of breast implant surgery. Its prevalence varies from 0.5 to 30 percent,1 depending on the coating of the prosthesis, the type of prosthesis used, the planar placement of the prosthesis, precautions taken intraoperatively and postoperatively, and possibly other as-yet-unidentified contributing factors. Despite increased application of best surgical practices and textured devices leading to reduced rates of capsular contracture, the latter remains the cause of reoperation and most common complications after breast implant surgery.2 To date, the exact pathogenesis of capsular contracture remains unknown, and the process