Optimal Integration of Postmastectomy Radiotherapy with Breast Reconstruction
Several reconstruction options are utilized after mastectomy, and can be categorized into two major groups; 1) prosthetic implants, which can either be placed in a one-step procedure or with an expander placed at the time of mastectomy and permanent implant placed during a separate delayed surgical procedure; and 2) autologous implants using the patient’s own tissue, which can also occur at the time of mastectomy, or as a delayed procedure after radiotherapy. The approach to reconstruction often depends on several factors including need for radiation, surgical practice patterns, patient anatomy and comorbidities, and patient preference. Radiation has been shown to increase the risk for reconstruction complications, especially after prosthetic implant placement. The optimal type of reconstruction and sequencing of radiation and reconstruction remains controversial. The timing of various implant and reconstruction procedures may have a significant impact on treatment planning, risk for reconstruction complications and overall cosmesis.
This program is designed to meet the interest of radiation oncologist and residents-in-training.
- Describe the major reconstructive options used after mastectomy as well as timing of reconstruction relative to RT.
- Describe issues related to sequencing of RT to locoregional control and implant-specific outcomes in patients who receive both neoadjuvant and adjuvant chemotherapy with each type of reconstruction
- Describe how breast reconstruction and oncoplastic surgery techniques in breast-conserved patients impact the technical delivery of RT and dose to normal tissues.
The following people served as the developers of this activity and their disclosures are listed below.
- Barbara Fowble, MD, is employed as a professor at University of California, San Francisco and has no financial relationships with a commercial interest.
- Alice Ho, MD, is employed at Memorial Sloan Kettering Cancer Center and has no financial relationships with a commercial interest.
Babak Mehrara, MD, is employed at Memorial Sloan Kettering Cancer Center and has no financial relationships with a commercial interest.
Hani Sbitany, MD, is employed at the University of California, San Francisco and has no financial relationships with a commercial interest.
Additionally, the Education and CME/MOC Committees had control over the content of this activity.
The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council of Continuing Medical Education to provide continuing education to physicians.
ASTRO is awarded Deemed Status by the American Board of Radiology to provide SA-CME as part of Part II Maintenance of Certification.
- 1.50 Certificate of AttendanceThis activity was designated for 1.00 AMA PRA Category 1 Credit™.
- 1.50 SA-CME
The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council of Continuing Medical Education to provide continuing medical education for physicians.
The American Society for Radiation Oncology (ASTRO) designates this Enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This activity meets the American Board of Radiology's criteria for a self-assessment activity in the ABR's Maintenance of Certification program. Participation in this course in combination with the successful completion of the corresponding assessment and course evaluation adheres to the guidelines established by the ABR for 1.50 self-assessment credits.
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