Download PDF
J Reconstr Microsurg 2017; 33(05): e6
DOI: 10.1055/s-0037-1609015
Letter to the Editor
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Response to Letter to the Editor

Evan Matros
1   Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
› Author Affiliations
Further Information

Publication History

20 October 2017

26 October 2017

Publication Date:
12 December 2017 (online)

    Permissions and Reprints

Letter to:

National Breast Reconstruction Utilization in the Setting of Postmastectomy RadiotherapyJ Reconstr Microsurg eFirst
DOI: 10.1055/s-0037-1598201

National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy: Two-Stage Implant-Based Breast Reconstruction

Re: National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy: Two-Stage Implant-Based Breast Reconstruction

We agree with several of the comments by our colleagues about the recent publication entitled, “National Breast Reconstruction Utilization in the Setting of Post-mastectomy Radiotherapy: Two-Stage Implant-Based Breast Reconstruction.” [1] An ideal reconstructive algorithm remains to be determined for patients who go on to need adjuvant radiotherapy. However, as pointed out, autologous transfer can mitigate some of the side effects of radiotherapy. We also agree that there is a need for high-quality prospective studies to determine the impact of radiotherapy on autologous flaps. The available literature is conflicted on this topic with some centers in support of radiating flaps while others prefer delayed autologous transfer.[2] Anecdotally, our reconstructive unit has seen unsalvageable flaps following radiation with fat necrosis, dense fibrosis, and recurrent infections to the flap. Such a scenario has “burned a bridge” leaving no reconstructive back-up plan. Lastly, many women do not desire autologous flaps or have inadequate adipose reserves. In these cases, most authors recommend immediate implant or tissue expander placement at the time of mastectomy as expansion of radiated chest wall skin is unreliable in most circumstances.[3]

Letter to this article:

Re: National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy: Two-Stage Implant-Based Breast ReconstructionJ Reconstr Microsurg 2017; 33(05): e4-e5
DOI: 10.1055/s-0037-1612602

Letter to this article:

National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy: Two-Stage Implant-Based Breast ReconstructionJ Reconstr Microsurg 2017; 33(05): e3-e3
DOI: 10.1055/s-0037-1604389

 

  • References

  • 1 Razdan SN, Cordeiro PG, Albornoz CR. , et al. National breast reconstruction utilization in the setting of postmastectomy radiotherapy. J Reconstr Microsurg 2017; 33 (05) 312-317
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Kelley BP, Ahmed R, Kidwell KM, Kozlow JH, Chung KC, Momoh AO. A systematic review of morbidity associated with autologous breast reconstruction before and after exposure to radiotherapy: are current practices ideal?. Ann Surg Oncol 2014; 21 (05) 1732-1738
    CrossrefPubMedGoogle Scholar
  • 3 Cordeiro PG, McCarthy CM. A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: part II. An analysis of long-term complications, aesthetic outcomes, and patient satisfaction. Plast Reconstr Surg 2006; 118 (04) 832-839
    CrossrefPubMedGoogle Scholar