Reply: Immediate Hybrid Breast Reconstruction: Dual-Plane Approach Using Prepectoral Implants and Retropectoral Fat Grafting

We thank Dr. Munhoz1 for his constructive comments regarding our study, “Immediate Hybrid Breast Reconstruction: Dual-Plane Approach Using Prepectoral Implants and Retropectoral Fat Grafting.”2 We are pleased that he recognizes the potential value of the retropectoral plane as a recipient site for autologous fat grafting and shares our view that this hybrid approach may help address some limitations of conventional implant-based breast reconstruction. At present, the use of retropectoral fat grafting is a relatively new technique that is increasingly applied in various breast surgery settings.3–6 Our experience with its application in combination with prepectoral implants, as described in the study, is limited to our initial cases. Nevertheless, we based this approach on prior experience in autologous breast reconstruction, where issues such as injection-related complications and fat graft survival have already been evaluated.7,8 To date, with more than 100 cases of retropectoral fat grafting procedures performed and some patients having reached their 1-year follow-up, the results are promising, with a low complication rate and long-lasting graft integration, comparable to that seen in other grafting sites. At this stage, only the cumulative experience of multiple centers can provide a broader understanding of outcomes and predictable complications, as no large randomized prospective trial with extended follow-up is yet available. Such studies, as highlighted by Dr. Munhoz, are desirable to gain further insights. With regard to volumetric assessment, a magnetic resonance imaging–based calculation using the ellipsoid formula remains the standard practice in clinical research. Although this method may carry inaccuracies, particularly in irregularly shaped grafts, it is currently the only widely described and reproducible approach. Its simplicity facilitates comparison between patients and studies, while advanced imaging modalities may improve accuracy in future investigations. We also acknowledge that fat graft resorption is a dynamic process that may extend beyond the first year. The 6-month magnetic resonance imaging timepoint was chosen as a clinically relevant early assessment, since the majority of resorption occurs within this period. Follow-up is ongoing within our cohort and will provide additional information on long-term stability. In conclusion, we appreciate the interest in our work and the constructive feedback. Our results support the feasibility and potential advantages of combining prepectoral implant placement with retropectoral autologous fat grafting. We hope that our study encourages further investigations with longer follow-up and refined techniques to more accurately evaluate fat retention in the retropectoral space. DISCLOSURE The authors certify that, to the best of their knowledge, no financial support or benefits have been received by any author, by any member of their immediate families, or by any individual or entity with whom or with which they have a significant relationship from any commercial source that is related directly or indirectly to the scientific work reported on in this communication. The authors have no financial interest in any of the products, devices, or drugs mentioned in this communication.