J reconstr Microsurg
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 (eFirst)

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]