Response to Letter to the Editor
20 October 2017
26 October 2017
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.” 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. 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.
- 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 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
- 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