## 4 Discussion
The occurrence of capsular contraction is known to be a result of the inflammation caused by the surface of the implanted silicone material [4; 5]. As a result, it's critical to comprehend the mechanism of capsular contraction development and identify appropriate preventive techniques. Fibroblasts and macrophages are principal elements detected in microscopic analyses of the fibrotic capsule adjacent to the breast implant [30]. They are detected in large number in 'the contact zone' of the implant, reason why they are associate with the capsular contracture severity. [PERSON] et al. claim that the macrophages are the cells that produce initiation of repair and remodelling process entering the first in action before fibroblasts being possible that macrophages have an influence on the functions of fibroblasts. However, the exact relationship between macrophages and fibroblasts in the process of capsular formation it has not been sufficiently explored [31]. Numerous methods have been described in the literature to prevent and reduce the risk of capsular contraction such as: placing the implant in the submuscular plane, dissecting a larger pocket, performing a rigorous haemostasis to prevent hematoma, using implants with a textured surface, minimizing exposure, contact and handling of the implant, irrigation of the pocket with antiseptic solutions or bactericidal solution to prevent infectious processes, use of steroid therapy, immunomodulatory and anti-inflammatory drugs [32; 33; 34; 35; 36; 37; 38; 39; 40]. The autologous fat graft offers potential applications in breast reconstruction. While smaller volumes of fat injection are used to correct contour asymmetries, larger amounts of injection offer alternatives for augmenting the entire breast [17]. The use of autologous fat transfer for the purpose of breast reconstruction extends beyond the remodeling of breast volume or asymmetry. Other therapeutic applications considered include the treatment of postmastectomy pain syndrome, pain due to capsular contracture, and irradiated tissue fibrosis [16; 41; 42; 43]. Recent studies in the literature suggest that adipose tissue contains a cell fraction (adipose-derived stromal cells and/or stem cells) that contributes to improving wound cicatrisation process, tissue repair, and extracellular matrix remodelling [44]. [PERSON] et al. found that autologous fat transfer can relieve pain caused by capsular contracture and reduce the degree of contracture from Baker 4 to 3. Treatment is in several stages of fat injection around the implant requiring a longer period of time. The authors attributed the pain relief to the differentiation and softening of the tissues that decreased the compression of nerves [43]. Studies performed on burn scars using autologous adipose tissue grafting have shown a reduction in tissue thickness, with improved elasticity and decreased stiffness both subjectively quantified by patient perception and objectively by histopathological examination [44]. We investigated the efficacy of different strategies that can reduce inflammation and decrease peri-implant fibrosis. Comparing the results from our four study groups we revealed that fat grafting has the capacity to determine the favourable impact on dermal elasticity and thickening by reducing tissue inflammation. The study's main limitation was that it was ended after the eighth week. However, long-term experimental and clinical studies are needed to evaluate the evolution of the capsule around the silicone implant over time and the impact of autologous fat transfer in reducing the degree of capsular contracture.