Kinda annoying on surgeons part to do a simultaneous breast reduction at the time of a lumpectomy. One would think a lumpectomy was enough of a breast reduction as it is.
Regardless, oncoplastics seems hard to get around if there are no clips to mark the edge of the lumpectomy cavity. I'm glad the surgeons at my institution don't do it on a routine basis. If you would boost the patient normally, I don't see the overtly dangerous harm in attempting to boost what looks most like the lumpectomy cavity on CT (would look at US/Mammo from pre-op to assist with localization). Gfunk's method seems reasonable but likely the potential for mildly worse skin toxicity to the entire breast?
But in general, at my institution we don't boost the lumpectomy scar; we boost the cavity. Often times they are essentially one and the same, but with more peri-areolar incisions (to improve cosmesis) reaching back into whatever area of the breast the cancer is in to pull the cancer out on a lumpectomy, it would seem to make more sense to boost the cavity where the tumor was rather than the scar.
Post-mastectomy RT gets a boost to the scar.
