Abstract
Sir:FigureWe congratulate Dr. Nahabedian1 for his important letter in response to the article published by Nava et al.2 in August of 2011 in this Journal, and for highlighting once again to plastic surgeons the topic of radiotherapy and breast reconstruction. Postoperative radiotherapy does interfere with breast reconstruction (both autologous and prosthetic). Immediate expander/implant reconstruction is particularly affected by unplanned postoperative radiotherapy, with an increased rate of capsular contracture and infection, possibly leading to implant removal. To overcome this problem, currently two techniques have been described: (1) the Memorial Sloan-Kettering Cancer Center protocol,3 based on a superfast expansion with implant positioning before radiotherapy (which ultimately leads to tissue stretching but not to a real expansion); and (2) the delayed-immediate breast reconstruction4 (where the drawback is performing a free flap on an irradiated field). Since 2010, we have been treating these cases with lipofilling with adipose-derived stem cells after irradiation on the filled expander.5 Lipofilling is planned during the subacute phase of injury (6 to 12 weeks after irradiation), just as Dr. Nahabedian correctly points out. Expander exchange for the permanent implant is planned 12 weeks after lipofilling. Results have been extremely encouraging, with impressive new tissue formation (Fig. 1), similar to what Serra-Renom et al. find in delayed cases,6 and a protective effect on contracture and infections. A multicenter study is ongoing for further validation of this protocol.Fig. 1: Intraoperative photograph of a female patient during second-stage breast reconstruction (expander/prosthesis). The patient underwent immediate breast reconstruction following radiotherapy. After the lipofilling treatment with adipose-derived stem cells, new tissue formation can be observed. Subq, subcutaneous; Pec., pectoralis.Diego Ribuffo, M.D. Matteo Atzeni, M.D. Department of Surgery, Section of Plastic Surgery, Cagliari University Hospital, Monserrato, Italy DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.
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