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The concept, the technique, and the application they describe to overcome radiotherapy-induced complications in immediate expander-implant breast reconstruction are not new. More specifically, I personally described and published this method for the first time in 20112 when I was working at Cagliari University, widening then the indications with further experiences reported also in this Journal,3–5 when I returned to La Sapienza University in Rome. We are aware of the use of our protocol in more and more breast centers, especially in the north of Italy (Bonomi et al.), and this is a further input for us to continue. A multicenter, prospective, randomized study with longer follow-up as suggested by Cordeiro6 would probably help. Again, we congratulate Maione et al. for pursuing solutions to this difficult problem. DOI: 10.1097/PRS.0000000000000932

Diego Ribuffo, M.D. Federico Lo Torto, M.D. Matteo Atzeni, M.D. Francesco Serratore, M.D. Department of Surgery P. Valdoni Sapienza University Rome, Italy Correspondence to Dr. Lo Torto Sapienza University of Rome Via ettore Fieramosca n. 200 Rome 00159, Italy

DISCLOSURE All authors hereby declare that they do not have any potential conflict of interests and that they have not received funding for this work. REFERENCES

Letters The Effects of Postmastectomy Adjuvant Radiotherapy on Immediate Two-Stage Prosthetic Breast Reconstruction: A Systematic Review Sir:

W

e read with great interest the Viewpoint1 published by Maione et al. in the May issue of the Journal entitled “The Effects of Postmastectomy Adjuvant Radiotherapy on Immediate Two-Stage Prosthetic Breast Reconstruction: A Systematic Review.” The first author (D.R.) knows the authors personally, and they have contributed a lot in the field of regenerative surgery, and their report highlights again how important this topic is. Copyright © 2014 by the American Society of Plastic Surgeons

1. Maione L, Forcellini D, Vinci V, Lisa A, Caviggioli A, Klinger F. The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: A systematic review. Plast Reconstr Surg. 2012;133:729e–730e. 2. Ribuffo D, Atzeni M, Serratore F, Guerra M, Bucher S. Cagliari University Hospital protocol for alloplastic breast reconstruction and unplanned radiotherapy: A preliminary report. Eur Rev Med Pharmacol Sci. 2011;15:840–844. 3. Ribuffo D, Atzeni M. Outcome of different timings of radiotherapy in implant-based breast reconstruction: Clinical evidence of benefit using adipose-derived stem cells. Plast Reconstr Surg. 2012;130:498e–499e. 4. Ribuffo D, Atzeni M. Protective lipofilling allows immediate implant-based breast reconstruction in the setting of postoperative radiotherapy. Plast Reconstr Surg. 2013;131:848e–849e. 5. Ribuffo D, Atzeni M, Guerra M, et al. Treatment of irradiated expanders: Protective lipofilling allows immediate prosthetic breast reconstruction in the setting of postoperative radiotherapy. Aesthetic Plast Surg. 2013;37:1146–1152. 6. Cordeiro PG. Reply: Protective lipofilling allows immediate implant-based breast reconstruction in the setting of postoperative radiotherapy. Plast Reconstr Surg. 2013;131:849e.

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The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: a systematic review.

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