Journal Logo



Chang, David W. M.D.

Author Information
Plastic and Reconstructive Surgery: September 2010 - Volume 126 - Issue 3 - p 1119-1120
doi: 10.1097/PRS.0b013e3181e6068f
  • Free


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:

  1. 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?
  2. 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

[email protected]


1.Khan MAA, Srinivasan K, Mohan A, Hardwicke J, Rayatt S. Breast reconstruction and lymphedema (Letter). Plast Reconstr Surg. 2010;126:1118–1119.
2.Chang DW, Kim S. Breast reconstruction and lymphedema. Plast Reconstr Surg. 2010;125:19–23.

Section Description


Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS' enkwell, at

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

©2010American Society of Plastic Surgeons