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	Since this article does not have an abstract, we have provided the first 148 words of the full text and any section headings.

In Reply: We agree with Dr van der Veldt and colleagues that silicone particles can be found in intact fibrous capsules of silicone breast implants and in draining lymph nodes, even in the absence of rupture or evident leakage. The frequency with which silicone particles are found may also depend on the manufacturer and the type of textured surface of the implants.^1-2

The histological material available in our retrospective study was relatively limited, precluding in-depth evaluation of this feature. We did find foreign body reaction in 4 of 5 specimens and equivocal signs of silicone material in only 1. The biological mechanisms underlying an association between ALCL and breast implants are not resolved. If the association is confirmed, we believe it likely that there is an indirect immunological drive mediated by cytokine response. However, this would not necessarily require the presence of detached silicone material in the capsule.

Daphne de Jong, MD, PhD
d.d.jong@nki.nl
Department of Pathology

Flora E. van Leeuwen, PhD
Department of Epidemiology
The Netherlands Cancer Institute
Amsterdam, the Netherlands

1. Peters W, Smith D, Lugowski S, McHugh A, Keresteci A, Baines C. Analysis of silicone levels in capsules of gel and saline breast implants and of penile prostheses. Ann Plast Surg. 1995;34(6):578-584. ISI | PUBMED 2. Beekman WH, Feitz R, van Diest PJ, Hage JJ. Migration of silicone through the fibrous capsules of mammary prostheses. Ann Plast Surg. 1997;38(5):441-445. FULL TEXT | ISI | PUBMED

JAMA. 2009;301(12):1227.

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