Radiotherapy for Breast Cancer before and after Immediate Prosthetic Breast Reconstruction: A Case Report of Six Patientswith Review of the Literature

Abstract

Objective: This manuscript aims is to present the difficulties involved in optimizing dosimetric distribution, based on six cases of patients who underwent radiotherapy before or after breast implant surgery. Materials and methods: Clinical characteristics, imaging, anatomical pathological and immunohistochemical data, treatment (neoadjuvant or adjuvant chemo- therapy, subcutaneous mastectomy surgery with axillary curage, radiotherapy before or after breast implant placement and difficulties in dosimetric coverage). Results: Patients aged 37, 30, 48, 32, 44, and 36 years were followed for invasive breast carcinoma of luminal B, triple-negative, Luminal B Her2-positive, triple-negative breast diagnosed by anatomical pathology and immuno-histochemistry. They received either neoadjuvant or adjuvant chemotherapy, or subcutaneous mastectomy with breast implant or breast prosthesis before or after radiotherapy. Radiotherapy with breast implants in the pre-pectoral, retro pectoral, and axilla clavicular CTVs was delivered at a dose of 50 Gy (2Gy per session) or 40.05 Gy (2.67Gy per session). Better optimization of dosimetric distribution was difficult to achieve in the pre-pectoral, retro pectoral, and axilla supra clavicular CTV, as the breast implant was considered a high-risk organ. Conclusion: Direct, permanent breast reconstruction using a breast implant or prosthesis is an increasingly popular treatment option. It minimizes the psychological, social, and aesthetic repercussions of mastectomy. However, there are still significant challenges to be overcome when adequately planning dosimetric distribution for radiotherapy.