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W e read the article entitled " Patient-Reported Outcomes after Irradiation of Tissue Expander versus Permanent Implant in Breast Reconstruction: A Multicenter Prospective Study" 1 with great interest. We thank the authors for this useful study and would like to ask some questions.The authors researched the uncertainty surrounding the timing of radiation therapy in two-stage breast reconstruction after mastectomy and the effect of radiation therapy timing on complications. In their study, the authors report two different algorithms: radiation therapy of the tissue expander followed by the exchange procedure (237 patients in the before-exchange group) versus radiation therapy to the permanent implant after the exchange procedure (80 patients in the after-exchange group). Complication rates and reconstruction success of these two patient groups were compared.Postmastectomy radiation therapy reduces the risks of locoregional failure, any recurrence, and breast cancer mortality for patients with T1-2 breast cancer with one to three positive axillary nodes. 2 On the other hand, radiotherapy can cause wound healing problems, capsule contracture, and necrosis in mastectomy skin flaps. These complications affect the success of the reconstruction and the quality of the aesthetic result. 3 The use of acellular dermal matrix increases the complication rates (such as infection, seroma) in breast reconstruction. 4,5 Did excessive use of acellular dermal matrix in the before-exchange group cause complications or reconstruction failures?How long was the time interval between mastectomy and expander/permanent implant exchange operation in the two groups (before exchange and after exchange)? On average, how long was the time to start radiation therapy in the two groups? Was there a delay in patients receiving radiation therapy in the after-exchange group? Was any neoadjuvant therapy given to the patients in this group, considering that there may have been a delay in receiving radiotherapy?

W e have read with interest the article "Twelve Years of Establishing the Strategies for Tongue Reconstruction" by Nguyen. 1 However, there are some points that we wonder about the infrahyoid myocutaneous flap that we want to use in our clinic. Please enlighten us on this matter.According to the experience of the author, in an 11-year case series, local and free flaps were used for the reconstruction of 328 patients with tongue scc after resection. Ipsilateral neck dissection was performed in some patients, and bilateral neck dissection was performed in others. Infrahyoid myocutaneous flap and supraclavicular artery island flap were preferred as local flap options. Radial forearm, lateral arm, ALT, and rectus abdominis free flap options were used.Considering the complication rates in the study, the success of the reconstruction is obvious, and we congratulate the author. In addition, postoperative photographs sampled from the case series have added visual richness to the article. Howard et al 2 reported their 10-year experience in using submental flaps for the reconstruction of oral cavity cancer defects in terms of the oncological safety of the technique. Is the use of an infrahyoid myocutaneous flap an option for reconstruction of the tongue defect in patients undergoing neck dissection? Is it safe from an oncological point of view? Have you evaluated patients for tumor recurrence after adaptation of the infrahyoid myocutaneous flap to the tongue defect? Is the recurrence due to the primary tumor, or can a secondary recurrence be distinguished from the use of a flap from a region with lymph node metastasis, although neck dissection was performed?We would be pleased if you share your experiences with us. Thank you in advance.