title: Does partial expander deflation exacerbate the adverse effects of radiotherapy in two-stage breast reconstruction?
abstract: BACKGROUND
  The optimum protocol for expander volume adjustment with respect to the timing and application of radiotherapy remains controversial.
  
  
  METHODS
  Eighteen New Zealand rabbits were divided into three groups. Metallic port integrated anatomic breast expanders of 250 cc were implanted on the back of each animal and controlled expansion was performed. Group I underwent radiotherapy with full expanders while in Group II, expanders were partially deflated immediately prior to radiotherapy. Control group did not receive radiotherapy.The changes in blood flow at different volume adjustments were investigated in Group II by laser Doppler flowmetry. Variations in the histopathologic properties of the irradiated tissues including the skin, capsule and the pocket floor, were compared in the biopsy specimens taken from different locations in each group.
  
  
  RESULTS
  A significant increase in skin blood flow was detected in Group II with partial expander deflation. Overall, histopathologic exam revealed aggravated findings of chronic radiodermatitis (epidermal atrophy, dermal inflammation and fibrosis, neovascularisation and vascular changes as well as increased capsule thickness) especially around the lower expander pole, in Group II.
  
  
  CONCLUSIONS
  Expander deflation immediately prior to radiotherapy, may augment the adverse effects, especially in the lower expander pole, possibly via enhanced radiosensitization due to a relative increase in the blood flow and tissue oxygenation.
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey. beletzden@yahoo.com
authors.forename: Burcu
authors.initials: B
authors.lastname: Celet Ozden
authors.forename: Erdem
authors.initials: E
authors.lastname: Guven
authors.forename: Isik
authors.initials: I
authors.lastname: Aslay
authors.forename: Gonul
authors.initials: G
authors.lastname: Kemikler
authors.forename: Vakur
authors.initials: V
authors.lastname: Olgac
authors.forename: Merva
authors.initials: M
authors.lastname: Soluk Tekkesin
authors.forename: Bengul
authors.initials: B
authors.lastname: Serarslan
authors.forename: Burcak
authors.initials: B
authors.lastname: Tumerdem Ulug
authors.forename: Aylin
authors.initials: A
authors.lastname: Bilgin Karabulut
authors.forename: Atilla
authors.initials: A
authors.lastname: Arinci
authors.forename: Ufuk
authors.initials: U
authors.lastname: Emekli
mesh_terms: D000818:Animals; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D062109:Dermatologic Surgical Procedures; D005260:Female; D008279:Magnetic Resonance Imaging; D016462:Mammaplasty; D008408:Mastectomy / Q000534:rehabilitation*; D011817:Rabbits; D011832:Radiation Injuries / Q000209:etiology*; D018787:Radiation Oncology; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation; D012867:Skin / Q000098:blood supply* / Q000473:pathology; D015626:Tissue Expansion / Q000009:adverse effects*; D015625:Tissue Expansion Devices