Reducing Capsular Contracture Formation in Breast Augmentation with Silicone Implants: Experimental Study on Rats

Round 1

Reviewer 1 Report

This manuscript presents the comparison of 4 different methods for reducing the inflammatory reaction around the silicone implant. Through histological evaluations, the authors concluded that the group with autologous centrifugated fat could reduce acute and chronic inflammation. Although the manuscript includes interesting implant methods, the manuscript needs to be improved. Therefore, I could not recommend the current manuscript to be published in Applied Sciences. I recommend that the current manuscript should revise to include answers to the following questions.

 

1. The authors claim biocompatibility evaluation based on histological evaluations. However, figures do not sufficiently display the results. For example, figures 1,2, and 3 do not include immune response results well. In particular, implantation figures (Fig.1(a), Fig. 2(a) and Fig. 3(a)) are not necessary. The authors would better display the problematic cases: 2 capsular contractures in the control group, 1 ulcerated implant in the rifampicin group, 2 capsular contractures in the rifampicin group, 2 ulcerated implants in the dexamethasone group, and adherent implant in the autologous centrifuged fat group. Except Fig. 3(c), figures do not demonstrate problematic cases well. The reader may be difficult to understand what happened to the implants.

 

2. If the authors want to claim biocompatibility based on histological results, histological images should demonstrate acute and chronic response with implantation time information. Since all images do not include implantation time information, I could not agree with the authors' conclusions such as “Histology assessment: in the control group was observed an active chronic inflammation associated with giant foreign body cell reaction.”

 

3. Figure 9 should be improved for publication. Axis labels do not include sufficient information that the readers can understand. I cannot understand what are V1 and count. What do numbers of x-axis mean? Graph titles do not include any information. We all know the graph is the bar chart. Legends should be revised. What do numbers (0 and 1) mean?

 

4. Tables 1 and 2 should be improved for publication. What does V1 mean? I guess that V1 is a contracture capsule. The correlation between contracture and other parameters was shown. Pearson correlation is demonstrated between -1 and +1. EOZ and Macrophage units are % and their scores look like under 1. Based on the authors’ conclusion, % should be removed. The numbering form would better be revised:,102 to 0.102 and -,035 to -0.035.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

  As a reviewer I believe that claifications are needed:

1. Why did the groups of rats have diferent (8,17, 12, 11)?
2. Was the fact of using large amounts of Betadine solution for skin disinfection justified (including Figure 2a, 4a, 4a)? Did Betadine solution nod penetrate the skinafter incision, and thus Iodine influenced the course of the experiment?
3. Whether the lack of immobilization of rats during the implantations procedure could not affect its course and the healing of the tissues of the "pocket"?
4. Whether the lack of sterile protection of the operating firld of the skin could affect the safety of antiseptics.
5. What was the quantification of the inflammatory infiltration of the capsule surrounding the implant?
6. Table 2 should be set entirely on one page of the manuscript - without dividing the lines into two pages.

Author Response

Please see the attachement

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

With minor spell check, I recommend the manuscript for publication in
Applied Sciences.