W e read with great interest the article by Amy S.Colwell and Erin M. Taylor, entitled "Recent Advances in Implant-Based Breast Reconstruction." 1 This article aims to describe the indications for implantbased breast reconstruction with or without nipple or skin preservation, the advantages/disadvantages of the use of acellular dermal matrix/mesh, and the main features of the different types of implants available.During the past year, several authors 2-5 considered the same topic. We would like to acknowledge their findings and to add our thoughts on advances in implant-based breast reconstruction, as follows.Nahabedian 3 observed that round, form-stable, silicone gel implants and non-form-stable silicone gel implants for breast reconstruction have comparable outcomes and complication risk. In terms of infection, seroma, breast implant-associated anaplastic large cell lymphoma, capsular contracture, and rupture, no significant differences were detected. 3 Nevertheless, with non-form-stable silicone gel implants, less obvious flipping and edge visibility were reported. 3 Regarding the choice between saline implants and silicone-filled implants, Gabriel and Maxwell 2 observed that saline implants allow easier detection of ruptures, as they deflate and are less expensive than silicone implants. In contrast, saline implants have a less natural feel, as the consistency on palpation resembles that of water rather than the viscous feel of natural breast tissue, as agreed by Colwell and Taylor. 1,2 Furthermore, saline implants have a higher risk of rippling and rupturing than silicone implants and might cause bottoming-out over time because of the distribution of the implant's weight at the lower pole. 2 Regarding the use of textured or smooth breast implants, there is a consensus regarding the association of breast implant-associated anaplastic large cell lymphoma with textured breast implants, even if this is not common. 1 A recent study 5 on 62 postmastectomy patients compared shaped microtextured implants and round smooth implants. Although quality of life and satisfaction were similar in both groups, round smooth implants appeared to be better in terms of softness and volume and were less frequently associated with rippling, whereas shaped microtextured implants proved to be better in the profile delineation.The safety of silicone breast implants was investigated by Rohrich et al., 4 considering the possible morbidities and systemic interactions of silicone implants. The authors conclude that at the present state, there is overwhelming evidence to support the safety of silicone breast implants and that there is no scientific evidence for the so-called silicone implant illness syndrome. 4 In our opinion, during the preoperative consultation, all the advantages/disadvantages of the different types of implants available for breast reconstruction should be carefully explained to the patient, to meet the optimal implant-based breast reconstruction outcomes.
