Innovative Management of Implant Exposure in ADM/Implant-Based Breast Reconstruction with Negative Pressure Wound Therapy

We have read with attention and interest the article entitled ‘‘Innovative Management of Implant Exposure in ADM/Implant-Based Breast Reconstruction with Negative Pressure Wound Therapy’’ [1].We agree with the authors in asserting that immediate breast reconstruction is a good opportunity, with less discomfort for the patient. Also we agree in saying that the difficult and psychologically tough decision for the patient, similar to some malformation syndromes or major pathological states [2]. We appreciate the intentions for a rapid management of exposure of the prosthesis, through the use of negative pressure therapy. We draw attention to some possibilities. In fact, as already published in the literature the use of negative pressure therapy in breast reconstruction provides important resources [3]. Specifically, as reported by Ju Yong Cheong et al., VAC therapy with instillation (VeraflowTM KCI USA, Inc, San Antonio, TX) could be a viable alternative to conventional negative pressure therapy [4, 5]. The instillation advantage is the continuous washing of the submuscular pocket; this reduces the formation of biofilm and breaks down the bacterial load. In the work mentioned previously, the authors have performed one week of continuous washing of the pocket with saline solution, after they repositioned the prosthesis. The negative pressure system with instillation works intermittently and alternates 15 min of washing with saline solution at 45 min of negative pressure to -75 mm Hg. Furthermore, the intermittent instillation use maintains a submuscular pocket of appropriate volume; in fact the authors use the same measure of prosthesis. Compared to the paper of Accurso et al., the timing of hospitalization of the patient was lower (3 vs 1 weeks) with the use of VAC Instiller, and this resulted in a reduction in the biological and medical cost.