Subcutaneous implant-based breast reconstruction, a modern challenge in postmastectomy radiation planning

Mitchell, Melissa; Wagner, Jamie L.; Butterworth, James A.

doi:10.1016/j.prro.2017.09.001

Cited by 15 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is also a challenge for radiation oncologists and medical physicists. Prospective trials are necessary to ensure that these new techniques do not compromise oncologic outcomes [13][14][15][16].…”

Section: Effect Of the Calculation Grid On The Results Of The Dose Distributionmentioning

confidence: 99%

Radiotherapy treatment planning for breast cancer patients after a subcutaneous mastectomy with the use of a prosthesis or expander

Kędzierawski

Buliński

Kuszewski

et al. 2021

Nowotwory. Journal of Oncology

View full text Add to dashboard Cite

Introduction. Medical physicists planning radiation treatment are increasingly confronted with situations that require special attention. Undoubtedly, one such situation is the postoperative irradiation of a patient with breast cancer in which there is a prosthesis or an expander. In recent years, expanders have appeared in this location, which, due to the density of the device's valve makes it difficult to prepare an acceptable treatment plan. The study aims to present treatment planning in these situation in various Polish cancer centres and to compare overall patient preparation for the treatment. Material and methods. A questionnaire was prepared and sent to more than 20 radiotherapy departments, which included basic questions regarding the preparation of an irradiation plan for patients treated for breast cancer after a subcutaneous mastectomy with immediate reconstruction with a prosthesis or expander. The survey encompassed eight radiotherapy departments. Results. Not all radiotherapy departments require a manufacturer's certificate, which shows that the manufacturer does not prohibit the use of a prosthesis/expander during treatment with ionizing radiation. The X 6MV photons and the supine position, total and fraction doses: from 40 to 60 Gy and from 2 to 2.67 Gy, respectively, are the most commonly used. The way of defining them also depends on the oncological centre. The most commonly used irradiation technique is VMAT. Conclusion.The conclusion from the questionnaire -no standardisation of treatment planning -should encourage the community, at least medical physicists, to develop rules of conduct in this case. Irradiation techniques are mainly dynamic ones. The expander or prosthesis does not significantly affect the dose distributions.

show abstract

Section: Effect Of the Calculation Grid On The Results Of The Dose Distributionmentioning

confidence: 99%

Radiotherapy treatment planning for breast cancer patients after a subcutaneous mastectomy with the use of a prosthesis or expander

Kędzierawski

Buliński

Kuszewski

et al. 2021

Nowotwory. Journal of Oncology

View full text Add to dashboard Cite

show abstract

“…Later on, because of the good results of soft tissue replacement devices in a dual plane approach, the rationale in favor of using such devices as a full coverage of TE/I was developed and published first by means of synthetic meshes [9], and immediately after by acellular dermal matrixes (ADMs) [10], thus starting again the era of a subcutaneous approach, this time considered a conservative reconstruction with a complete muscle sparing technique. More recently, many experiences and series have been published in literature reporting the growing popularity of this novel approach in BR [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. And nowadays several algorithms and selection criteria have been proposed to identify the candidates of this new, very popular, approach [26].…”

Section: Introductionmentioning

confidence: 99%

Pre-pectoral breast reconstruction: early and long-term safety evaluation of 146 unselected cases of the early pre-pectoral era of a single-institution, including cases with previous breast irradiation and post-mastectomy radiation therapy

et al. 2021

View full text Add to dashboard Cite

We re-evaluated acute and early-late toxicity-related factors among pre-pectoral immediate tissue expander/implant (TE/I) breast reconstruction (BR) unselected, first-era, cases, including previous breast radiation treatment and post-mastectomy radiation therapy (PMRT). A retrospective analysis of 146 (117 therapeutic and 29 prophylactic) pre-pectoral reconstructions, between 2012 and 2016, considered patient-related (age, body mass index [BMI], smoke-history, comorbidity, BRCA mutation), and treatment-related characteristics (previous irradiation, axillary surgery, PMRT, pre-and postoperative chemotherapy, endocrine therapy, and target-therapy). Safety was evaluated as acute and early-late complications, and TE/I failures. At multivariate analysis of the 146 cases (117 patients submitted to BR) a significant factor related to acute toxicity was: BMI ≥ 25 (31.3% [≥ 25] vs 8.8% [< 25]; OR 4.44, 95% CI 1.56-12.6; p = 0.003), while previous breast surgery on ipsilateral side presented a borderline significance (31.6% [previous surgery] vs 7.4% [no previous surgery]; OR 3.74, 95% CI 0.97-14.40; p = 0.055). Factors significantly related to TE/I failure were: current or previous smoking exposition (13.8%[smokers] vs 2.6% [non-smokers]; OR 7.32, 95% CI 1.37-39.08; p = 0.02) and preoperative chemotherapy (18.8% [yes] vs 3.5% [no]; OR 8.16, 95% CI 1.29-51.63; p = 0.026). At 4-year median follow-up, 3 deaths, 5 locoregional recurrences, and 14 distant metastases occurred. Immediate pre-pectoral BR is safe and effective, with low rates of acute and early-late complications. BMI and previous breast surgery were related to higher complications but not failure; smoking and preoperative chemotherapy were related to TE/I explant. Previous RT and PMRT were related neither to early-late toxicity nor failure.

show abstract

“…Prepectoral prosthetic breast reconstruction has gained popularity with emergence of Acellular Dermal Matrix (ADM) but remains controversial [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Nipple-Sparing Mastectomy with Immediate Prepectoral Implant-Based Reconstruction: A Case Report

et al. 2019

View full text Add to dashboard Cite

Unusual setting of medical care Background: Technical innovations allow endoscopic nipple-sparing mastectomy (NSM), which is well tolerated and associated with greater patient satisfaction. Endoscopic technique did not have wide diffusion; many centers have abandoned this technique because of technical challenges. Implant-based reconstruction (IBR) remains the most common form of breast reconstruction. Current techniques involve partial or total coverage of the implant with pectoralis major muscle to prevent exposure or infection. Muscle dissection has functional and cosmetic consequences. Case Report: We present a case of 45-year-old patient presenting with personal history of right breast cancer. The patient requested left prophylactic mastectomy. We used a 4 cm-long single hidden scar on axillary line. Endoscopic nipple-sparing mastectomy was done using a single port with 3 sleeves. Immediate breast reconstruction was performed by inserting a silicon implant in prepectoral plane without Acellular Dermal Matrix (ADM). At 6 months postoperatively, no complication had been reported. The patient was satisfied with the result and no further correction was necessary. Conclusions: Endoscopic surgery is a valuable option for nipple-sparing mastectomy. This method is a less expensive alternative technique to robotic approach. It could enable safe prepectoral IBR without placement of ADM and with lower risk of complications.

show abstract

Subcutaneous implant-based breast reconstruction, a modern challenge in postmastectomy radiation planning

Cited by 15 publications

References 20 publications

Radiotherapy treatment planning for breast cancer patients after a subcutaneous mastectomy with the use of a prosthesis or expander

Radiotherapy treatment planning for breast cancer patients after a subcutaneous mastectomy with the use of a prosthesis or expander

Pre-pectoral breast reconstruction: early and long-term safety evaluation of 146 unselected cases of the early pre-pectoral era of a single-institution, including cases with previous breast irradiation and post-mastectomy radiation therapy

Endoscopic Nipple-Sparing Mastectomy with Immediate Prepectoral Implant-Based Reconstruction: A Case Report

Contact Info

Product

Resources

About