LAUSR

Dear Editor, We have read with great interest the article entitled ‘‘Identifying Preoperative Factors Associated with the Volume Discrepancy in Patients Undergoing Breast Reconstruction with the Extended Latissimus Dorsi Musculocutaneous Flap Coverage’’ by Kim et al. [1] in Aesthetic Plastic Surgery. In this article, the researchers successfully showed that the excised skin area and breast volume were preoperative factors associated with volume discrepancy in patients undergoing breast reconstruction with latissimus dorsi (LD) flap through a single-center, retrospective study, which obviously facilitate surgeons to predict the lack of volume and plan further secondary procedures. We would like to congratulate Jun Hyeok Kim and coworkers for their wonderful paper. Nevertheless, some questions with regard to the research still need to be put forward and clarified. Firstly, compared with traditional intraoperative measurement of the weight of the LD flap to indirectly evaluate the lack of volume between the flap and contralateral breast, it is wise of researchers to regard volume discrepancy (breast volume–flap volume) as a direct prediction for the surgical plan. Notwithstanding, it is as a matter of fact that preoperative flap volume cannot fully represent intraoperative and postoperative flap volumes. One study found that an average decrease of 54.5% was observed in the LD volume between the images obtained immediately postoperatively and the scans obtained 6–8 months after surgery [2]. Recently, Mericli et al. [3] recommend that surgeons should include enough volume with the latissimus dorsi flap to make the reconstructed breast 10–15% larger than the contralateral breast in order to cope with postoperative atrophy. To guarantee good patient satisfaction, we still suggest that secondary procedures to optimize the long-term aesthetic result should be discussed with the patient during the initial consultation owing to potential volume discrepancy between the postoperative breast and perioperative flap. Furthermore, taking their solo measurement of preoperative flap volume into consideration, we recommend that the volume of the intraoperative flap and reconstructed breast should also be documented in detail to refine and optimize the calculation of volume discrepancy to finally assist surgeons in making a precise prediction. Secondly, after careful analysis of their formula, we noticed that the coefficient of skin defect size (0.0639) was larger than that of breast volume (0.0025), which indicates that the skin defect size may play a more importance role in determining volume discrepancy compared with breast volume. However, years of experience on more than 300 breast reconstructions with LD flaps told us that patients with large contralateral breast volumes may be prone to suffer from lack of volume. Consequently, we guess that it is due to inclusion of too many small breast volume patients (Mean: 252.2 ml) and a small sample size that eventually influenced the coefficient of variables. Meanwhile, it is much better to show us the figure of skin defect size simulation in the paper to help us get a good & Chunjun Liu [email protected]