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Radiation therapy and breast reconstruction: A survey of best practice agreements among plastic surgeons and radiation oncologists
Michael Schroeder, MD
Walter Jungbauer, BS
Sachan Jhawar, MD
Clara Lee, MD
Michael Sorkin, MD
The Ohio State University
2023-02-10
Presenter: Michael Schroeder, MD
Affidavit:
Original work
Director Name: Gregory Pearson
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
More than one third of women diagnosed with breast cancer will undergo a mastectomy as part of their cancer care. For select patients with node-positive disease, large tumor size or positive resection margins, post-mastectomy radiation therapy (PMRT) decreases local recurrence and improves overall survival. However, radiation therapy poses a number of reconstructive challenges including increased infection, implant exposure, reconstruction failure, and fibrotic skin changes. Similarly, for the radiation oncologist, reconstruction can pose unique challenges to providing effective radiation therapy requiring alternate delivery strategies and delaying initiation of treatment. While both disciplines work closely together, research has focused on outcomes within one specialty in isolation of the other. Therefore there is a need to better understand interdisciplinary decision making and perceptions among radiation oncologists and plastic surgeons. Our study explores best practice agreements on clinical decision making among plastic surgeons and radiation oncologists in treating patients in the setting of PMRT breast reconstruction. Clinical decisions related to reconstructive approach and radiation therapy delivery were explored via a survey sent to both specialties. The survey was created and validated within our institution before being sent out to plastic surgeons and radiation oncologists nationally. Results of our survey identified areas of agreement, disagreement, and uncertainty between the two specialties in how to provide optimal care to patients undergoing PMRT and breast reconstruction. Our study identifies potential areas of change to improve the multidisciplinary care of patients undergoing PMRT and breast reconstruction.
