by Harman, John;
Govender, Stan; Simpson, John; Benjamin, Benji
Summary: In
New Zealand, oncoplastic surgery is common, but partial breast reconstruction
presents challenges for radiation therapy targeting. Tissue rearrangement
creates ambiguity when targeting the tumor bed, with resultant overestimation
of treatment volumes. Thus, adoption of advanced methods of radiation therapy
have been hindered. This pilot study describes use of a novel three-dimensional
implant that provides a scaffolding for tissue ingrowth during partial breast
reconstruction and delineates the tumor bed more precisely to assist radiation
planning and mammographic surveillance. After informed consent, 15 women were
implanted with the three-dimensional bioabsorbable implant. The device was
sutured to the tumor bed during lumpectomy, and tissue flaps were mobilized and
attached to the implant. Visualization of the marker and radiation treatment
volumes were recorded and compared. The implant provided volume replacement and
helped to maintain breast contour. Cosmetic outcomes were excellent; no device-
or radiation-related complications occurred. One patient had a postoperative
hematoma that resolved after percutaneous drainage; there were no postoperative
infections. Three-year follow-up shows no tumor recurrences and no untoward
effects. When compared to conventional radiation targeting, use of the implant
showed that a greater than 50 percent reduction in treatment volume was
possible in some cases. Three-year mammograms show no significant artifact,
normal tissue ingrowth, and minimal fibrosis. This study describes a method of
oncoplastic breast reconstruction using an implantable device that marks the
site of tumor excision and provides for volume replacement with tissue
ingrowth. Patients tolerated it well, and radiation therapy planning,
positioning, and treatment were facilitated.
