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Abstract

Sir:FigureIn the article published by Rigotti et al.,1 there are some interestingly debatable and criticizable points in the methodology. In the Results of the original article by Rigotti et al.,1 the authors stated that “a dependent-group analysis was based on the evaluation of different time periods for the same patient.” This historical self-control method cannot be reliable, as the timely related oncologic treatment and decline of recurrence creates the bias of comparison. Moreover, in their further comment, the authors themselves agree that “it would be criticizable because the risk of locoregional recurrence decreases with time and cannot be considered as equivalent in the prelipofilling and postlipofilling periods.” Despite the fact that the authors did well to create an independent-group analysis with matched age, radiotherapy, tumor size, axillary node involvement, and histology, it still lacks matching of other important biological features such as hormonal receptor status, HER2/neu, and Ki-67. Neither follow-up duration nor oncologic treatment and timing was mentioned and matched in these groups.2 These oncologic features certainly influence the incidence of local relapse. In their original article,1 the authors themselves are aware that “the lack of an independent control patient group hinders generalization from the reported results.” In conclusion, the evidence from both study methods is too weak to support the statement that “lipofilling ultimately turns out to have a negligible influence on locoregional relapses events.” However, we agree with the authors that further studies are needed and fat grafting should be performed with caution and proper oncologic follow-up.3,4 Jean Yves Petit, M.D. Francesca De Lorenzi, M.D., Ph.D. Visnu Lohsiriwat, M.D. Mario Rietjens, M.D. Division of Plastic Surgery, European Institute of Oncology, Milan, Italy DISCLOSURE The authors have no conflicts of interest to declare in relation to the content of this communication. No outside funding was received.