Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

To the Editor,

I would like to congratulate Dr. James and colleagues for their paper in which they investigated bacterial adhesion on several implant shell materials [3]. I have a few comments related to the in vitro implication of their results.

First, former studies have investigated bacterial growth on smooth and textured implants after explantation, showing equal bacterial growth on both types of implants [2]. How do the authors explain these in vivo findings compared to their in vitro study?

Second, several studies have shown that capsular contracture occurs more often in smooth implants in comparison with textured implants [1]. Since it is suggested that bacteria might cause capsular contracture, one would expect more bacterial growth on (more) smooth surfaces. However, the present study shows the contrary.