title: Immediate breast reconstruction with anatomical implants following mastectomy: The radiation perspective.
abstract: Immediate implant-based breast reconstruction followed by postmastectomy radiation therapy (PMRT) is controversial because of the risk of compromised treatment plans and concerns regarding cosmetic outcomes. We evaluated the effects of immediate direct-to-implant breast reconstruction with anatomical implants on the quality of PMRT delivered by 3-dimensional conformal radiotherapy (3D-CRT). In this retrospective, single-institution study, patients who had undergone reconstruction with direct anatomic implant, performed by a single surgeon, received 3D-CRT between 2008 and 2013. For each patient, 2 plans (including or excluding internal mammary nodes [IMN]) were created and calculated. The primary end point was the dose distribution among reconstructed breasts, heart, lungs, and IMNs, and between right and left breasts. Of 29 consecutive patients, 11 received right-sided and 18 received left-sided PMRT to a total dose of 50Gy. For plans excluding IMN coverage, mean Dmean for right and left reconstructed breasts was 49.09Gy (98.2% of the prescribed dose) and 48.51Gy (97.0%), respectively. For plans including IMNs, mean Dmean was 49.15Gy (98.3%) for right and 48.46Gy (96.9%) for left reconstructed breasts; the mean IMN Dmean was 47.27Gy (right) and 47.89Gy (left). Heart Dmean was below 1.56Gy for all plans. Mean total lung volume receiving a dose of ≥ 20Gy was 13.80% to 19.47%. PMRT can be delivered effectively and safely by 3D-CRT after direct-to-implant breast reconstruction with anatomical implants, even if patients require IMN treatment.
authors.affiliation: Radiation Oncology Unit, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: Merav.ben-david@sheba.health.gov.il.
authors.forename: Merav
authors.initials: M
authors.lastname: Ben-David
authors.affiliation: Radiation Oncology Unit, Chaim Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Hila
authors.initials: H
authors.lastname: Granot
authors.affiliation: Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Gelernter
authors.affiliation: Department of Surgery, Assuta and Herzliya Medical Centers, Ramat Gan, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Scheflan
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008168:Lung / Q000528:radiation effects; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000379:methods*; D012189:Retrospective Studies
keywords: 3-Dimensional conformal radiotherapy; Acellular dermal matrix; Anatomical implant; Immediate breast reconstruction; Internal mammary nodes; Postmastectomy radiation therapy