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• W3159371370 abstract "Sir: We read with great interest the article by Schaverien et al.1 and congratulate the authors. Their article adds to the evidence highlighting the versatility of partial breast reconstruction with chest wall perforator flaps in allowing breast-conserving surgery in women with higher tumor-to-breast ratios, especially in women with less ptotic breasts for whom volume displacement oncoplastic breast surgery may not be an option. Although no data were presented, the authors do allude to the potential challenges of delivering, where indicated, adjuvant tumor bed boost radiotherapy following this surgery. As opposed to volume displacement techniques, where the possible tumor bed relocation following parenchymal rearrangement was identified early as a potential problem to planning of boost delivery, the accuracy of tumor bed contouring after volume replacement surgery has not been debated, based on the fact that in the latter the tumor bed is not relocated.2 We recently initiated understanding of delivery of tumor bed boost radiotherapy in this setting, published initial data, and proposed a potential alternative approach to tumor bed contouring.3 Our study reviewed the radiotherapy planning scans of 28 chest wall perforator flap patients and compared the tumor bed volume identified by an oncologist using cavity clips (oTB) with the surgical specimen volume. Data suggested that tumor bed contouring based solely on clips can produce an underestimation of the boost target volume (average surgical specimen volume − oTB = −42.85 ml). On the other hand, tumor bed identified by combining the clips with the flap delineated by a surgeon on planning computed tomography scan (sTB) appeared to provide a closer correlation of target volume with the surgical specimen volume (average surgical specimen volume − sTB = −1.02 ml). Contrary to volume displacement techniques, where the cavity walls are apposed, in chest wall perforator flaps, the tumor bed is undisplaced, leaving the cavity walls separated by the flap filling the surgical defect. When planning boost radiotherapy in these patients, an underestimated volume may only represent the non–breast flap tissue filling the lumpectomy defect. Conversely, a larger target volume would include the undisturbed surgical cavity plus a rim of breast parenchyma adjacent to the tumor bed. Thus, as we highlight,3 with current technology and expertise, boost radiotherapy planning and administration may require further refinement to avoid impairment of long-term aesthetic outcome due to boost-related adverse effects, such as local fibrosis or major fat necrosis.3,4 As a potential solution, we proposed a ring-shaped boost marked as 5-mm rim of breast tissue around the tumor bed in partial breast reconstruction. Such a boost, although difficult to reproduce in practice due to dose diffusion and other complex planning factors, may improve accuracy of the target site and volume.3 DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Emanuele Garreffa, M.D.Breast SurgeryUniversity HospitalDerby, United KingdomBreast SurgeryUniversity HospitalBurton, United Kingdom Amit Agrawal, M.B.B.S., M.S., D.M.Breast SurgeryCambridge University HospitalsCambridge, United Kingdom" @default.
• W3159371370 created "2021-05-10" @default.
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• W3159371370 date "2021-05-06" @default.
• W3159371370 modified "2023-10-17" @default.
• W3159371370 title "Outcomes of Volume Replacement Oncoplastic Breast-Conserving Surgery Using Chest Wall Perforator Flaps: Comparison with Volume Displacement Oncoplastic Surgery and Total Breast Reconstruction" @default.
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• W3159371370 doi "https://doi.org/10.1097/prs.0000000000007917" @default.
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