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

Response to Letter to the Editor

We read your article “National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy” and found the data on immediate breast reconstruction (IBR) that you pointed out really interesting.

It is very newsworthy how IBR practice has developed since 2004 in both radiated and nonradiated patients. It is even more significant to note that since 2008, implants surpassed autologous reconstruction as the most common IBR method despite the possibility of postmastectomy radiotherapy (PMRT).[1]

The clinical practice at our unit follows the trend you have described. However, we noticed that PMRT could cause some difficulties in heterologous IBR as biomaterial alterations or capsular contracture.[2]

To support your research, we would like to share our IBR trend, especially after we introduced our protocol. We apply two-stage implant-based breast reconstruction, which starts with tissue expander insertion immediately after mastectomy. Then, patients undergo postmastectomy radiotherapy and when they finish the PMRT cycles, we evaluate regional skin and soft tissue damage. If needed, one or two autologous fat tissue grafts are performed to restore compromised soft tissues.

Once lipofilling allows skin recovering, we proceed with the second stage of reconstruction.[3]

The protocol described above has led our unit to reach encouraging results in immediate breast reconstruction, thereby reducing autologous reconstructions.[4]

IBR is proved to be fundamental in breast cancer affected patients, as it is associated with enhanced postoperative health-related quality of life.[1] We think that more studies are needed in this direction to achieve the possibility of IBR in almost all patients who undergo mastectomy, considering the central role that the acellular dermal matrix could have in the future.[5]

• 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
• 2 Ribuffo D, Lo Torto F, Giannitelli SM. , et al. The effect of post-mastectomy radiation therapy on breast implants: unveiling biomaterial alterations with potential implications on capsular contracture. Mater Sci Eng C 2015; 57: 338-343
• 3 Lo Torto F, Vaia N, Ribuffo D. Postmastectomy radiation therapy and two-stage implant-based breast reconstruction: is there a better time to irradiate?. Plast Reconstr Surg 2017; 139 (06) 1364e-1365e
• 4 Ribuffo D, Lo Torto F, Atzeni M, Serratore F. The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: a systematic review. Plast Reconstr Surg 2015; 135 (02) 445e
• 5 Casella D, Bernini M, Bencini L. , et al. TiLoop® bra mesh used for immediate breast reconstruction: comparison of retropectoral and subcutaneous implant placement in a prospective single-institution series. Eur J Plast Surg 2014; 37 (11) 599-604