The patient in our study was closely monitored using CT scans, which delineated the breast prosthesis and its adjacent structures clearly. No untoward changes were noted throughout the entire course of radiation treatment. In particular no contour and shape changes such as dimpling, tenting, crimping were noticed. The prosthetic device appeared intact with no evidence of fluid leakage, seroma formation or tissue necrosis. No changes were noted to the structures in close relation prosthesis, such as ribs, muscles and chest wall.

Multiple dosimetric calculations performed during treatment, revealed acceptable changes (+/-2%) in the dose distribution of the breast mound throughout the radiation course. canadian antibiotics

The patient completed her radiation course on schedule, with no treatment breaks. During the course of radiation treatment the patient did not experience any unacceptable side effects. Clinical examination during treatment was normal with no signs of seroma, infection or tissue necrosis. She did not experience any untoward pain requiring medications. Weekly port films revealed no abnormalities confirming that prosthesis was well within the planned radiation field. At completion the routine post radiation instructions were given. The placement of a permanent prosthesis was scheduled at 4 months post radiation treatment. During this observation period, no alterations were done to the prosthesis, such as increasing or decreasing the volume of fluid. She was followed up by us and by her surgeon. Following completion of treatment, we did a 15-day, 3-month and 6-month follow-up on the patient. No unacceptable loco-regional effects were seen. Also cosmetic changes, like skin discoloration, were comparable to those encountered in patients receiving radiation therapy to an intact breast. The surgeon explained that he did not experience any difficulty in the dissection of the prosthetic bed or in the insertion of the permanent breast prosthesis. No abnormal wound healing reactions were noted postoperatively. The patient was satisfied with her cosmetic appearance.

Figure 7. CT scans obtained prior

Figure 7. CT scans obtained prior to initiation of radiation documenting the prosthesis and its relation to adjacent structures.

However, in the dosimetric calculations performed on hypothetical situations with exaggerated prosthesis deformations, gross discrepancies were evident. In one case, an additional amount of fluid (50 ml) was injected. This caused a 1cm extension of the prosthesis outside the superior border of the planned radiation treatment field. In this instance computer dosimetry calculations revealed greater than 10% variation from the original treatment dose. Similarly deliberate dimpling of the prosthesis resulted in dosimetric discrepancy greater than 10% above the accepted norm. Also deflation of the prosthesis, caused by removal of fluid, resulted in unsuitable dosimetric plans. In radiation therapy, greater than 10% variation of dosimetric plan is unacceptable. Such changes in the size and shape of the tissue expander cause either over and/or under dosing and decreases the probability of tumor control. This can result in a high incidence of loco-regional failure, apart from causing psychological stress to the patient, pain, morbidity due to multiple surgical interventions and poor cosmetic result.

Figure 8. CT scans obtained

Figure 8. CT scans obtained at completion of radiation treatment. No abnormalities were noted in the prosthesis or in the structures adjacent to it.

Even though we did not simulate any leakages in the prosthesis, review of literature reveals that leakage leads to loco regional failure as well as improper cosmesis. These are explained further in the discussion part of this paper. tadacip