Reply To Invited Discussion On: The Bovine Pericardium Matrix In Immediate Implant-Based Breast Reconstruction

Abstract

We thank Dr. Khoobehi for his interest in our article ‘‘The bovine pericardium matrix in immediate implantbased breast reconstruction’’ and for his thoughtful comments on our study [1]. We performed a retrospective study which, in accordance with our ethical committee, did not require a new informed consent at the time of the data collection. This is why we commented ‘‘for this type of study (observational retrospective study, as mentioned above in our paper), formal consent was not required.’’ Furthermore, we would reassure Dr. Khoobehi that we share the same sentiment and ethical duty as he does in his practice, with the goal to adequately inform our patients. Each of our 123 patients was transparently informed, through multiple interviews before undergoing surgery, about the surgical plan, the alternative options and the use of the bovine pericardium matrix for the purpose of immediate breast reconstruction. Each of them signed a specific and comprehensive informed consent before surgery. No new consent was required at the time the study was conducted. The author brings up some valid suggestions, including indocyanine green angiography, to decrease the early complication rate of the mastectomy skin flap necrosis, that is not directly related to the bovine pericardium matrix. We will certainly consider this technique in our future work. We thank the author for his meticulous considerations about the rate of the animation deformity in our paper (0.7%). Two subjective grading schemes for animation deformity were available in the literature at the time of our study. The first grading scheme was described by Becker et al. [2], and the second by Vidya et al. [3]: Both of them divided patients into one of four grades based on clinical subjective evaluation of the surgeon. In addition, in his classification Vidya specified whether distortion was noticed by the patient. Even if breast animation deformity was not the topic of our paper, we now take the opportunity to better clarify that in our study we focused mainly on the assessment of the Becker [2] grade IV patients: only patients with severe breast distortion, lateral or superior displacement of the implant and severe skin rippling were considered for detection of the animation deformity rate. In his comment, Dr. Khoobehi mentions exclusively the study of Nigro and Blanchet [4] in contrast to our study: In their report, they found 75 percent of patients experiencing animation deformity. According to the systematic review of the literature performed by Dyrberg DL et al. [5], it would be helpful to clarify that in the Nigro and Blanchet series the animation deformity was evaluated by the patients, using non-validated questionnaires. According to another review of the literature by Kim J. et al. [6], objective and clinical grading systems of the animation deformity are still relatively new: This is responsible for the underscoring of the very limited papers that have gone into the causes and implications behind that complication. We appreciate the opportunity to respond to the authors’ letter regarding our article and are excited to see how & Fabio Castagnetti [email protected]