Reply: Outcomes of Volume Replacement Oncoplastic Breast-Conserving Surgery Using Chest Wall Perforator Flaps: Comparison with Volume Displacement Oncoplastic Surgery and Total Breast Reconstruction.

Abstract

Sir: We have read with interest the comments of Dr. Al-Benna on our recently published article, “Outcomes of Volume Replacement Oncoplastic Breast-Conserving Surgery Using Chest Wall Perforator Flaps: Comparison with Volume Displacement Oncoplastic Surgery and Total Breast Reconstruction.”1 The abundance of perforators in the lateral and anterior thoracic regions and the presence of direct linking vessels between their adjacent perforasomes afford transverse extended flap designs with long length-to-width ratios.2,3 The vascular arrangements in this region are likely responsible, in part, for the very low complication rate of perforator flaps harvested from these regions. McCulley and colleagues reported outcomes of a large consecutive series of lateral chest wall perforator flaps, including lateral thoracic and lateral intercostal artery perforator flaps, for reconstruction of lateral partial breast defects.4 Of 75 cases, there was only one minor complication that occurred in a delayed lateral thoracic artery perforator flap: some venous compromise occurred but settled spontaneously, with complete flap survival and no fat necrosis clinically. In accordance with perforator flap principles,5 the fascia does not provide significant vascular contribution to these flaps, which are therefore fully islanded on the chest wall perforators to permit their excursion. As many blood supply options as possible are preserved within the flap design, sacrificing only those vessels that restrict flap movement and reach. We hope that this provides further clarity. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication or of the associated article. Mark Schaverien, M.B.Ch.B., M.D.. M.Sc., M.Ed.Geoffrey Robb, M.D.Department of Plastic SurgeryDivision of SurgeryUniversity of Texas M. D. Anderson Cancer CenterHouston, Texas