skin sparing mastectomies

[Pointless]

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The literature seems to indicate that SSM = MRM in terms of disease control. Does the performance of a SSM change your thinking at all about recommendations for PMRT? Do you do anything differently in terms of dosing and/or scar boost?

 

[Radiator20]

Does the performance of a SSM change your thinking at all about recommendations for PMRT? Do you do anything differently in terms of dosing and/or scar boost?

No and no.

 

[Palex80]

In cases with lymphovascular invasion and/or rather close margins, I do use a flap more often (=every day as long as tolerated).

Edit: lins = long

 

[scarbrtj]

In cases with lymphovascular invasion and/or rather close margins, I do use a flap more often (=every day as lins as tolerated).

I assume by flap you mean bolus

 

[Pointless]

I assume by flap you mean bolus

Yes, I assumed the same. What a wonderfully European way of saying bolus. I'm using it from here on.

 

[evilbooyaa]

Agree with no and no. Sometimes at my institution a 'skin sparing' mastectomy is more of a 'breast tissue sparing' mastectomy, cause I can still breast tissue (outside of the nipple areolar complex) at CT sim, but it's rare.

Never understood why we call it bolus, because that goes against every definition of bolus. I am definitely a bigger fan of calling it a flap. Gimme a 1cm flap on it!

 

[scarbrtj]

Yes, I assumed the same. What a wonderfully European way of saying bolus. I'm using it from here on.

Well, I wouldn't use a flap on a TRAM flap however.

 

[Pointless]

Well, I wouldn't use a flap on a TRAM flap however.

Rule #1: Never flap a flap.

 

[Palex80]

Indeed, a flap is a bolus. Interistingly one can find both the terms flap and flab, noone really knows which is one is the correct term.

 

[scarbrtj]

It's all the same thing, although it's the first time I've heard it called a "flap." Could be confusing, as "flap" is very much a surgical (mastectomy-ish) term, too. Free flaps, TRAM flaps, and so and and so forth. Can call stuff whatever you want I suppose when there's no universally accepted definition, standard, etc. A medical bolus gets a medication dose up to a certain level pretty quickly, so a radiation bolus is kinda like that: gets a dose of something (photons, electrons) in reliably. But heck you can call a USB key a goober. Or the Lost Ark a MacGuffin; a bolus is my MacGuffin.

 

[scarbrtj]

Rule #1: Never flap a flap.

I have seen some who flap the flap, although with its own blood supply in the case of a TRAM flap, I predict flap-induced flap toxicity is lower with flaps than sans flaps. But flaps do cause more acute toxicity of course and might be the factor most associated with poor cosmetic outcome in post-mastectomy RT. Some people get in a big flap about using a flap. They say that Americans are way more likely to flap than Europeans. Probably true.

There's a lot of data that skin-sparing mastectomy (SSM) is safe; usually the patient will be reconstructed (in SSM), and if so I don't flap in SSM cases. There is scant convincing data that flap use or non-use affects cancer outcomes: in an old study, recurrence rates were ~5% with or without routine flapping.

Finally, the American College of Radiology recommends most post-mastectomy patients get flapped, although they don't call it a flap...

They call it bolus 🙂

 

[taserlaser]

This thread has now turned to flapping one’s mouth about flapping flaps or not flapping flaps, or if flap flapped should be flab, or if the flab flapped should be a flap. One should also not forget that in pelvic treatments, one’s flab can self flap, or if the flapped flab is to be called a flap, one’s flapping flap can self flap. Flabulous.