I thank Dr. Khan et al.1 for their kind comments and constructive criticisms of our article.2 The purpose of our article was to address two controversial questions:
- Does delaying breast reconstruction, particularly when surgical dissection is required in the previously operated on and/or irradiated breast, lead to a higher incidence of lymphedema?
- Does delayed autologous tissue flap breast reconstruction reduce the severity of lymphedema symptoms in patients who have existing lymphedema after mastectomy?
Because of its retrospective nature, this study had many drawbacks, as Dr. Khan and colleagues have pointed out. Of 444 delayed breast reconstructions performed, lymphedema developed in 16 cases. No significant difference in the incidence of postreconstruction lymphedema was noted between patients who did undergo and those who did not undergo radiotherapy before breast reconstruction: of the 16 patients who developed lymphedema after breast reconstruction, 10 had undergone preoperative radiotherapy and six had not. Also, no significant difference in the incidence of postreconstruction lymphedema was noted between patients who had undergone axillary lymph node dissection and those who had not undergone any lymph node dissection or biopsy.
All of our patients who developed lymphedema were evaluated by a certified lymphedema therapist. However, there were no changes in the frequency or method of conservative postreconstruction lymphedema therapy that would have been a cause of significant improvement of that lymphedema. Also, although one objective assessment used at our institution is a computerized volumetric analysis using optoelectric perometry, not all patients had this done; therefore, we were unable to provide such data for comparison.
David W. Chang, M.D.
University of Texas M. D. Anderson Cancer Center
1515 Holcombe Boulevard, Box 443
Houston, Texas 77030-4009
1.Khan MAA, Srinivasan K, Mohan A, Hardwicke J, Rayatt S. Breast reconstruction and lymphedema (Letter). Plast Reconstr Surg
2.Chang DW, Kim S. Breast reconstruction and lymphedema. Plast Reconstr Surg
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