Optimising post-operative radiation therapy after oncoplastic and reconstructive procedures

by Trine Tramm, Orit Kaidar-Person 

The Breast: Published: March 28, 2023

Abstract

Surgical techniques for breast cancer have been refined over the past decades to deliver an aesthetic outcome as close as possible to the contralateral intact breast. Current surgery further allows excellent aesthetic outcome even in case of mastectomy, by performing skin sparing or nipple sparing mastectomy in combination with reconstruction. In this review we discuss how to optimise post-operative radiation therapy after oncoplastic and breast reconstructive procedures, including dose, fractionation, volumes, surgical margins, and boost application.

Highlights

• New surgical procedures for breast cancer poses new challenges for the radiation oncologists.

• Oncoplastic breast surgery may question the ability to apply or the need for a tumour bed boost.

• Skin sparing/nipple sparing mastectomies should be planned to assure clear superficial margins.

• Radiation therapy indications, target volumes, dose and fractionation should be adapted per case to provide maximal clinical benefit and reduce toxicity.

• Multidisciplinary teamwork is needed from the time of diagnosis to plan the most appropriate locoregional therapy.