I would like to thank Dr. Knobloch for his letter and for his interesting comments on my article. I agree that the BREAST-Q evaluation method is very useful.
I am familiar with the studies by Hyakusoku, Mu, and Yoshimura and I am aware of the issues they raise. However, Dr. Knobloch seems to be mixing two procedures in his letter: in breast augmentation, fat is injected into an unoperated, healthy breast, and in the breast reconstruction technique my colleagures and I reported, it is injected in the subcutaneous plane in the skin of the thorax after a mastectomy.
In the first case, the injection of fat in the breast may alter the breast parenchyma and may produce calcification. I agree that the patient should be informed thoroughly of this risk. If calcifications do occur, they should be evaluated using magnetic resonance imaging.
In the procedure my colleagues and I perform, the fat is injected into subcutaneous tissue, which has already undergone surgery; the tissue may present internal scars and may have calcifications as a result of the earlier mastectomy.
In this situation, I follow patients clinically, as I do with all mastectomy patients. I only perform magnetic resonance imaging when I consider it necessary for the follow-up of the disease, not as a routine procedure.
I would like to thank Dr. Knobloch again for his interest in the article and for his comments.
Jose Maria Serra-Renom, Ph.D.
Instituto de Cirugía Estetica Dr. Serra-Renom
Plaza Alfonso Comín 5-7, 4a planta
Barcelona 08023, Spain
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