J reconstr Microsurg
DOI: 10.1055/s-0037-1604389
Letter to the Editor
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Federico Lo Torto1, Emanuele Cigna2, Juste Kaciulyte1, Donato Casella1, Marco Marcasciano1, Diego Ribuffo1
  • 1Department of Surgery “P. Valdoni,” Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
  • 2Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italy
Further Information

Publication History

05 June 2017

18 June 2017

Publication Date:
06 August 2017 (eFirst)

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]