Invited Response on: “Submuscular Reconstruction After NAC Sparing Mastectomy: Direct to Implant Breast Reconstruction with Human ADM Versus Tissue Expander”

Abstract

Sir We would like to thank the authors for the insightful discussion regarding our recent article, ‘‘Submuscular Reconstruction after NAC Sparing Mastectomy: Direct to Implant Breast Reconstruction with Human ADM Versus Tissue Expander’’ [1]. The aim of the study was to compare the two mentioned techniques for submuscular implant-based breast reconstruction in patients undergoing unilateral NAC sparing mastectomy with S-shaped incision located on the superoexternal breast quadrant. Patients with a minimum followup of 12 months from the reconstructive stage and no history of radiotherapy were included. We are glad to provide further data on the two study groups: the average mean age of the direct to implant (DTI) group at the time of reconstruction was 46 years, while of the two-stage group was 48 years; the average follow-up time from the reconstructive stage was 30 months for the DTI group and 22 months for the two-stage group; average BMI was 24.2 (range from 19.8 to 31.8) in the DTI group and 22.2 (from 19.9 to 25.7) for the two-stage group; in the DTI group 6 patients on 28 (21%) were smokers, and in the two-stage group 4 patients on 26 (15%) were smokers; none of the patients included in the study were affected by diabetes or vasculopathy; in the DTI group 4 patients on 28 (7%) underwent neo-adjuvant chemotherapy; and in the two-stage group 2 patients on 26 (7.7%) underwent neoadjuvant chemotherapy. All patients received a reconstruction with anatomical textured implants; implant volume ranged from 295 cc to 550cc (average 431cc) in the DTI group and from 290 cc to 520cc (average 373cc) in the two-stage group. We do not routinely collect the specimen volume, as the specimen volume includes the breast pyramid and the tail of Spence that should not be considered for the implant volume; the implant selection in our practice is driven by the footprint dimensions. The implant width is selected according to the breast footprint, subtracting the thickness of the skin flaps and adding 1 cm, the height of the implant is calculated according to the height of the contralateral breast, and sizers are used to confirm the correct projection [2]. The paper was developed in the context of breast reconstruction following an oncologic procedure. Such a framework carries additional challenges with respect to purely aesthetic breast modeling, as some anatomical & Rossella Sgarzani [email protected]