Abstract
Sir: Thank you for inviting us to reply to letter sent by Ribuffo et al. In our previous contribution, we described how our breast unit protocol manages expander insufflations and decreases the complication rate related to postmastectomy radiotherapy. In particular, in patients undergoing postmastectomy radiotherapy after first-stage breast reconstruction, we interrupt expansion and restart it 1 to 3 months after the end of radiotherapy. Then, we perform fat grafting 3 months before or at the time of expander substitution depending on late effects of normal tissue–subjective, objective, management, and analytic grade at the end of expansion.1 In patients with grade 1 late effects of normal tissue–subjective, objective, management, and analytic score, we proceed to fat grafting only during second-stage breast reconstruction, whereas in patients with higher grades, we perform fat grafting 3 months before second-stage breast reconstruction and at least 3 months after the end of radiation therapy and a second fat grafting procedure during expander substitution. Ribuffo et al. follow a different protocol based on complete tissue expansion before radiotherapy and two or three fat grafting sessions before second-stage breast reconstruction.2 In our previous contribution, we just presented our preliminary results3 using references to explain biological mechanisms implied in observed fat grafting clinical effects (histologic neovessel formation and tissue regeneration).4 Moreover, we considered the work by Rigotti more relevant, being the first article showing the therapeutic effects of autologous fat grafting on radiotherapy tissue damage.5 Concluding because of the Journal-permitted number of citations, we unfortunately missed the article by Ribuffo et al. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Luca Maione University of Milan Reconstructive and Aesthetic Plastic Surgery School Department of Medical Biotechnology and Translational Medicine BIOMETRA Plastic Surgery Unit Humanitas Clinical and Research Hospital Rozzano Davide Forcellini University of Milan Reconstructive and Aesthetic Plastic Surgery School MultiMedica Holding S.p.A. Plastic Surgery Unit Sesto San Giovanni Valeriano Vinci Andrea Lisa University of Milan Reconstructive and Aesthetic Plastic Surgery School Department of Medical Biotechnology and Translational Medicine BIOMETRA Plastic Surgery Unit Humanitas Clinical and Research Hospital Rozzano Fabio Caviggioli Francesco Klinger University of Milan Reconstructive and Aesthetic Plastic Surgery School MultiMedica Holding S.p.A. Plastic Surgery Unit Sesto San Giovanni, Italy
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
