Controlateral Symmetrisation in SRM for Breast Cancer: Now or Then? Immediate versus Delayed Symmetrisation in a Two-Stage Breast Reconstruction
, Dario Cassetti 3, Anna Lisa Pesce 2, Alessandro De Luca 4, Maristella Guerra 5, Roberto Cuomo 6, Diego Ribuffo 7, Alessandro Neri 8 and Marco Marcasciano 9Round 1
Reviewer 1 Report
In their manuscript titled Controlateral symmetrisation in SRM for breast cancer: “now 2 or then?”. Immediate versus delayed symmetrisation in two 3 stage breast reconstruction the authors discussed an interesting and debated topic, demonstrating that an immediate symmetrisation is a viable choice to provide immediate better satisfaction 248 and quality of life for patients
In my opinion this manuscript reads well and is carried out in scientific way.
Overall, it has coherent structure.
Both the topic, the used model and the set are clearly described in the abstract. The background information is very clear, too. The manuscript provides a useful contribution to the knowledge base. The list of references is relevant, recentand balanced. The section “Materials and methods” is well argued. The selection and sampling process is described in detail. Best practice standards were followed and ethical standards were maintained.
The results seem plausible and the collected data seem to be enough. You’ve explained their significance for a broader understanding.
It is worthy of publication
Author Response
We thank the reviewer for the opinion expressed on our manuscriptReviewer 2 Report
In this observational study, you have evaluated the possibility of an immediate symmetrisation in patients undergoing SRM (Skin-Reducing-Mastectomy), with reconstruction and prepectoral tissue expansions implanted, with specific covering devices.
The topics covered in this manuscript, address highly topical issues, namely, the prepectoral breast reconstruction, the use of covered devices in breast surgery and the possibility of a satisfactory reconstruction, even in the ptotic breast.
In these cases, the problem of an immediate contralateral symmetrisation is controversial, especially for all the problems related to adjuvant treatments (e.g.: RT, post-mastectomy necrotic complications, and infections).
The reconstructive technique with the tissue expander in SRM (Skin-Reducing-Mastectomy), mentioned in the text, seems to be a valid variant in patients with risk factors, and the reduction of the contralateral breast, would lead the patient to a better acceptance of her own body figure. From an objective point of view, it can be considered psychologically acceptable, on the other hand, the symmetrisation takes place in the same operation (mastectomy), and the definitive reconstruction is finalized in two surgical stages.
Revision#1
In my opinion, with these premises, the technical advantages associated with this surgical approach with the tissue expander and cover devices in selected patients, should be underlined.
· Add this concept succinctly in the conclusions.
Revision#2
Page 4, line 136: in the group with patients underwent delayed symmetrisation the time range in which the second time surgery took place is not described.
· Add in bracket
Author Response
Thanks for the suggestion. We agree with the reviewer on how contralateral symmetrization should not and cannot lengthen the time of any oncological therapies: in our experience we have reported how this has not happened (as reported on page 7 line 243) also thanks to the creation of a clinic dedicated to following mastectomised patients in which dressings are made, setting up a sterile field each time and ensuring the early treatment of any complications. Weanswer the two questions raised: Revision 1: We had underlined the technical advantages associated with this surgical approach with the tissue expander and cover devices in selected patients with this sentence added to conclusion "...Furthermore, the consolidated use of covering devices in prepectoral reconstruction, in selected patients, confirms how this technique can be applied with a low rate of complications..."
Revision 2: We had described ,in the group with patients underwent delayed symmetrisation the time in which the second time surgery took place with this sentence "...the second group 42 patients underwent delayed symmetrisation (performed after a median of nine months)..."
Reviewer 3 Report
I believe that the research has been carried out in respect of ethical law. It is scientifically correct and that it is of good quality
Author Response
We thank the reviewer for the opinion expressed on our manuscript