***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Epidemiologic data on local complications after breast augmentation  are scarce . In particular , few prospect ively collected data are available on modern breast implants on this issue . Using data from the Danish Registry for Plastic Surgery of the Breast , the authors examined determinants of surgery-requiring complications and capsular contracture grade s III to IV among 2277 women who underwent cosmetic breast implantation from June 1999 through April 2003 . During an average follow-up period of 1.6 years after implantation , 4.3 % of these women ( 3 % of implants ) required secondary surgery as a result of short-term complications . The most frequent clinical indications for surgery were displacement of the implant ( 38 % ) , capsular contracture grade s III to IV ( 16 % ) , ptosis ( 13 % ) , and hematoma ( 11 % ) . Overall , the authors found that inframammary incision and subgl and ular placement were associated with decreased risks of developing complications requiring surgical intervention , whereas implants larger than 350 mL increased the risk of such complications ( relative risk [ RR ] , 2.3 ; 95 % confidence interval [ CI ] , 1.3–4.0 ) . Thirty-nine Baker III to IV capsular contractures were identified , of which 22 were treated surgically within the study period . Submuscular placement of the implant decreased the risk of capsular contracture grade s III to IV ( RR , 0.3 ; 95 % CI , 0.2–0.8 ) , whereas surgical routes other than inframammary and drainage of implant cavity were associated with increased risk of capsular contracture . Current surgical practice s and modern implants used for breast augmentation produce fewer short-term complications than procedures and devices of the past . This prospect i ve study indicates that surgical procedures are more important predictors for local ( short-term ) complications than implant or patient characteristics Although textured silicone breast implants have been shown to reduce the incidence of capsular contracture , there is little evidence if this effect is maintained in the long term . It has been 10 years since the double-blind r and omized trial in which 53 patients received either Mentor smooth ( 26 ) or textured silicone gel implants  ( 27 ) . Of the 14 patients who were not known to have developed a contracture in the smooth group , 11 were review ed . Three had bilateral contractures . In the textured group , 18 of the 24 patients not known to have contractures were review ed . None had developed contractures . At 10 years , the incidence of capsular contracture was 65 percent of patients with smooth implants ( an increase of 6 percent on the 3-year results ) and 11 percent for the textured implant patients ( no change on the 3-year results ) . A data base containing the details of 1100 patients reinforces these results by examining the differences in contracture rates of textured , smooth , and polyurethane-coated implants . The effect of submuscular placement on reducing contracture rates regardless of texturing is discussed , as is the apparent increase in capsular contracture in patients who smoke We performed a prospect i ve , concurrently controlled , and blinded 4-year clinical study on 60 patient volunteers to determine the effects of two independent variables , Median 's Biocell texturization and Betadine antibacterial irrigation , on the incidence of fibrous capsular contracture around saline-inflatable implants following retromammary augmentation . Each patient was r and omly assigned both a textured and a smooth implant and both saline and Betadine irrigation so that each patient served as her own control . The textured devices irrigated with Betadine experienced an overall incidence of contracture of only 4 percent compared with 50 percent for the smooth devices irrigated with saline solution . The Betadine-irrigated devices in general had a lower incidence of contracture than the saline-irrigated devices , and the textured-surface devices in general had a lower incidence of contracture than the smooth devices . Antibacterial irrigation  and surface texturization may work in a cumulative manner to reduce the early incidence of capsular contracture Silicone breast implant surface texturing has been shown to reduce the short-term incidence of adverse ( Baker III/IV ) capsular contracture in augmentation mammaplasty in double-blind r and omised controlled trials . It is , however , undetermined whether the textured surface merely delays the onset of severe contracture or its effect on capsular contraction is persistent . The current study review ed , after three years , 49 of the 53 patients who had undergone subgl and ular breast augmentation mammaplasty in a r and omised double-blind study with textured or smooth silicone gel-filled implants in 1989 . The incidence of adverse capsular contracture was 59 % for smooth implants and 11 % for textured ones ( P = 0.001 ; chi 2 = 10.60 ) . Eight patients ( 31 % ) with smooth prostheses underwent breast implant exchange for severe capsular contracture between the one and three year assessment s , compared with a revisional surgery rate of only 7.4 % ( 2/27 patients ) for the textured group ( P < 0.04 ) . These adverse capsular contracture and revisional breast implant surgery rates clearly demonstrate that the effect of textured implants in reducing capsular contracture in augmentation mammaplasty found at one year is maintained at three years , and suggest that it may be long lasting There has been considerable interest in determining the effect of morphologic alterations of prosthetic surfaces on  capsule response in breast surgery . The purpose of this study was to provide a precise , three-dimensional evaluation of soft-tissue response to surface modifications in both implantation and expansion . Exp and able 100-cc prostheses were design ed with one of three surfaces : textured silicone ( Biocell ) , st and ard smooth silicone , or polyurethane ( Natural-Y , Meme ) . A new submuscular implantation site in the rabbit was developed . Each animal r and omly received a smooth-surface device on one side and either a textured silicone or polyurethane device on the other . In one group of animals , the prostheses were exp and ed monthly . Capsular response was evaluated monthly in vivo using st and ardized techniques as well as biomechanical methods for up to 6 months in the exp and er group ( n = 7 to 16 ) and 8 months in the implant group ( n = 7 to 15 ) . Analysis of biomechanical and histologic data revealed that prosthetic surface morphology can specifically alter capsular response . Polyurethane was the only effective surface in preventing capsular contracture in implantation . In expansion , both textured silicone and polyurethane surfaces result ed in significantly less capsular contracture and less resistance to expansion than comparable smooth-surfaced controls . Statistical comparisons reveal that the biomechanical methods utilized in this study provide the most precise and objective method of defining overall soft-tissue contracture around implanted bio material In a previous prospect i ve r and omized clinical study comparing in the same patient textured and smooth saline-filled mammary implants ( Biocell ) with large pore size ( 300 to 600 microm ) , we saw no difference in capsular contracture . This study was undertaken in a similar way to compare capsular contracture around smooth and textured saline-filled prostheses with pores of small size . During a period of 7.5 years , the breast hardness was followed up , and at the end of the study patient satisfaction was evaluated . Twenty healthy women with a mean age of 30 years were operated on for breast augmentation . Two surgeons performed all operations in a st and ardized way . Each patient received subgl and ularly a Siltex textured saline-filled prosthesis with a pore size of 30 to 70 microm in one breast , and a smooth saline-filled prosthesis in the other . The hardness of the breasts was evaluated after 0.5 , 1 , and 7.5 years using Baker grading and applanation tonometry .  Eighteen patients completed 1-year and 7.5-year follow-up . Two breasts with smooth prostheses were contracted after 6 months ( Baker III or IV ) . After 1 year , four patients with smooth prostheses and one with a textured prosthesis had capsular contracture ( p = 0.34 ) . Seven and one-half years after surgery , six patents with smooth and four with textured implants had contracture ( p = 0.66 ) . On two patients with smooth prostheses and one patient with a textured prosthesis , the capsule around the implant hardened between 6 and 12 months . Between 1 year and 7.5 years , three breasts with smooth and textured implants contracted and one with a textured implant softened . The patients reported on a Visual Analogue Scale ( 1 to 10 ) the impact of the augmentation on their quality of life to be 9 + /- 1 . Four patients preferred the breast with the smooth prosthesis , three preferred the breast with the textured prosthesis , and the others found both breasts equal . This study showed no significant difference of contracture with smooth versus fine textured implants . The majority of the patients preferred the smooth implants . The patients reported that the breast augmentation had had an extremely high impact on their quality of life & NA ; Capsular contracture consistently has been the most frequently noted complication of submuscular and subgl and ular breast augmentation . The etiology of this complication is still unknown , although silicone bleed , hematoma , infection , foreign bodies , and surgical trauma have been implicated . In this prospect i ve , double‐blind study , 61 women undergoing submuscular breast augmentation were r and omized  between Dow Corning textured and smooth‐walled silicone gel implants . Any consequent capsular contracture was assessed by an independent plastic surgeon and also by the patients themselves . Objective evaluation was made by applanation tonometry . It was found that depending on doctors , patients , and objective method used , 3 to 9 percent grade III and IV encapsulation followed submuscular augmentation with textured implants and 10 to 20 percent with smooth‐walled implants after 1 year . The differences were significant according to both patient assessment and applanation tonometry but not according to the physicians ’ evaluations . There was no correlation of capsular contracture with the age of the patient , duration of the operation , or degree of blood loss . There was a small but inconclusive difference in capsular contracture rate that favored the placement of textured rather than smooth implants in the submuscular pocket . ( Plast . Reconstr . Surg . 97 : 1200 , 1996 . The aim of this prospect i ve , controlled clinical investigation was to compare the capsular contracture rate between silicone implants with a smooth and those with a textured surface . The implants were otherwise identical . Twenty-five women with bilateral mammary hypoplasia underwent augmentation mammoplasty .  All received a textured implant on one side and a smooth implant on the other . Before surgery the patients were told that they could have the implants changed if the study showed that one type was better than the other . The investigation was conducted with the double-blind technique , with the code broken 1 year after surgery . At 1-year follow-up ( reported previously ) three parameters were used to estimate the tendency to capsular contracture : ( 1 ) the patient 's opinion on differences in hardness of the breasts , ( 2 ) the investigators ' classification of capsular contracture , and ( 3 ) applanation tonometry . All parameters showed unequivocally that the breasts augmented with textured implants had a lower tendency to develop capsular contracture than those with smooth implants . Five years after surgery 17 patients had had their smooth implant changed to a textured one because of hardness . Only one of the textured implants had been removed . A comparison between the 1-year and 5-year tonometric results of the 24 breasts that still had the original textured implants showed that after 5 years , a small but statistically significant increase in hardness had occurred compared with that after 1 year The frequency and severity of local complications remain the primary safety issues with silicone breast implants . The Danish Registry for Plastic Surgery of the Breast ( DPB ) , established in 1999 , prospect ively collects pre- , peri- and postoperative information regarding Danish women undergoing breast augmentation . Through DPB , we conducted a prospect i ve follow-up study of short-term local complications among 1090 women who underwent cosmetic breast implantation from June 1999 through October 2002 . Nineteen percent of women who underwent initial implantation developed at least 1 adverse effect . Forty percent of the adverse effects occurred within 3 months of implantation ; 79 % , within 6 months . Capsular contracture grade II-IV was observed among 4.1 % of women in the 2-year follow-up period . Overall , 97 ( 29 % ) of the 344 adverse effects among 55 ( 6 % ) of the 971 women required surgical intervention . A higher incidence of adverse effects typically occurred after subsequent implantations . According to the DPB experience , we conclude that most short-term postoperative adverse effects following cosmetic implantation are clinical ly insignificant and do not require treatment and that short-term complications requiring adjuvant treatment are rare In a prospect i ve , r and om , double-blind , and concurrently controlled clinical study of 124 patients having augmentation mammaplasty , using multiple independent subjective judges as well as objective compressibility measurements , the use of a variety of local antibacterials in or around inflatable retromammary prosthetic implants reduced the early postoperative onset of class III to IV capsular contracture by sevenfold ( 85 percent ) and the final incidence by more than half ( 50 percent ) ( p < 0.01 ) . We believe this study provides the most unequivocal evidence to date that the cause of capsular contracture in retromammary augmentation is periprosthetic bacterial contamination . Irrigation with a 5 percent povidone-iod 
    Output:
    
Interestingly , the self- assessment question naire revealed that capsular contracture or firmness is one ( albeit a very important factor ) of many facets in patient overall satisfaction .
This systematic review suggests that implant texturization reduces the incidence of early capsular contracture in subgl and ular breast augmentation .