Optimizing Breast Reconstruction through Integration of Plastic Surgery and Radiation Oncology

Abstract

Background: Post-mastectomy radiation therapy (PMRT) is an important adjunct to improve oncologic outcomes and survival in select breast cancer patients at increased risk for local recurrence. As recommendations for PMRT broaden, an increasing number of patients will have it included as part of their breast cancer treatment plan. Methods: This overview of the literature strives to broaden the exposure of the plastic surgeon to PMRT and describe the indications, guidelines, and considerations relevant to reconstructive surgery. The primary targets and dosing considerations will also be reviewed. Finally, the short- and long-term toxicities are outlined with the goal of providing the plastic surgeon insights with which to recognize certain toxicities in the clinic during follow up and to develop the fluency to be able to talk to patients about the potential for certain toxicities. Results: Generally, PMRT is safe and well tolerated. Considerations in breast reconstruction should be made on a patient-by-patient basis. Plastic surgeon familiarity with PMRT, its indications, and complications will amplify the surgeon’s ability to optimize outcomes. Conclusions: As more women undergo breast reconstruction, an increasing number of patients will have PMRT as part of their breast cancer treatment plan. By understanding the basic principles of PMRT, plastic surgeons can engage patients in conversations of shared decision-making and maximize outcomes.

Thinking like a Lawyer—Human Rights and Their Association with the Plastic Surgeon of Today

“…In addition, the specialist examination must be conducted by the respective state medical association [65]. This qualifies the plastic surgeon for reconstructive treatment of trauma and tumor patients, burn victims, and congenital defects, among others, and thus restores physical integrity [66][67][68][69][70]. The basic principles in reconstructive surgery with their increasingly complex therapeutic strategies for wound management are portrayed in the reconstructive ladder, which begins with healing by secondary intention and can extend to free flaps [71].…”