LAUSR

Comparing aesthetic outcome of various breast reconstruction modalities would certainly provide much needed information unfortunately still lacking for guiding consultation discussions with patients and for well-informed consent. Comparison of autologous and alloplastic techniques using three-dimensional surface imaging as proposed by Hartmann et al. [1] is a much appealing methodology for which they must be praised. Though they have acknowledged that breast asymmetry occurs in most healthy women, by comparing the outcome symmetry of 12 autologous breast reconstructions to 15 alloplastic reconstructions, the authors concluded that successful autologous and alloplastic reconstructions yielded highly symmetrical results with comparable outcomes. The mean symmetry index (SI) for semiautomatic measurements was M = 0.92 for the alloplastic group and M = 0.91 for the autologous group, and the mean SI for automatic measurements was M = 0.93 for the alloplastic group and M = 0.91 for the autologous group. The authors’ retrospective cohort study identified 183 patients who had undergone either autologous or alloplastic breast reconstructions in a 4-year interval. Patients with major complications defined as flap or implant loss were excluded. One hundred eighteen patients were selected for the investigation implying a rather disturbing 35.5% major complications and failure rate. No information is provided regarding distribution of these complications among the 2 reconstruction groups. Anyway, only 27 patients were available for final analysis. On close analysis of the study design and characteristics of the 2 study groups, we believe that the authors’ conclusion is probably misleading. Besides the 2 groups not being comparable in terms of patient ages and BMIs, serious differences were also present regarding unilateral or bilateral reconstructions and contralateral symmetrization; moreover, the alloplastic group was heterogeneous with 12 immediate implant reconstructions and 3 two-stage reconstructions with clearly different outcomes [2]; 8 cases were with ADM. Out of the 15 patients with alloplastic reconstructions, 13 had undergone bilateral reconstructions while 11 out of 12 patients had unilateral autologous inferior epigastric perforator Flap (DIEP-Flap) reconstructions, 4 of whom had consecutive contralateral mastopexy without indicating what was the type of contralateral reconstruction. Within the alloplastic group, 10 patients had nipple-sparing mastectomy, while 5 patients and all patients with autologous reconstructions had skin-sparing mastectomy. Two different anthropomorphic measurement methods were used to assess optical symmetry outcomes. Nine landmarks were defined, 5 of which were fixed (sternal notch, coracoid process, xiphoid, vertebra prominence, and nipple) while the remaining 4 (medial upper breast pole, lateral upper breast pole, lateral breast pole, lower breast & Fadel Chahine [email protected]