Evidence map›Paper›PMID 28507844›Full record

ArticlePlastic and reconstructive surgery. Global open2017

An Innovative Risk-Reducing Approach to Postmastectomy Radiation Delivery after Autologous Breast Reconstruction.

Merisa L Piper, Maristella Evangelista, Dominic Amara, David Daar, Robert D Foster, Barbara Fowble, Hani Sbitany

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Plastic and reconstructive surgery. Global open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Merisa L PiperDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif.; Department of Plastic and Reconstructive Surgery, University of California, Irvine, Calif.; and Department of Radiation Oncology, University of California, San Francisco, San Francisco, Calif.
Maristella EvangelistaDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif.; Department of Plastic and Reconstructive Surgery, University of California, Irvine, Calif.; and Department of Radiation Oncology, University of California, San Francisco, San Francisco, Calif.
Dominic AmaraDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif.; Department of Plastic and Reconstructive Surgery, University of California, Irvine, Calif.; and Department of Radiation Oncology, University of California, San Francisco, San Francisco, Calif.
David DaarDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif.; Department of Plastic and Reconstructive Surgery, University of California, Irvine, Calif.; and Department of Radiation Oncology, University of California, San Francisco, San Francisco, Calif.
Robert D FosterDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif.; Department of Plastic and Reconstructive Surgery, University of California, Irvine, Calif.; and Department of Radiation Oncology, University of California, San Francisco, San Francisco, Calif.
Barbara FowbleDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif.; Department of Plastic and Reconstructive Surgery, University of California, Irvine, Calif.; and Department of Radiation Oncology, University of California, San Francisco, San Francisco, Calif.
Hani SbitanyDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif.; Department of Plastic and Reconstructive Surgery, University of California, Irvine, Calif.; and Department of Radiation Oncology, University of California, San Francisco, San Francisco, Calif.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionPostmastectomy radiation therapy (PMRT) has known deleterious side effects in immediate autologous breast reconstruction. However, plastic surgeons are rarely involved in PMRT planning. Our institution has adopted a custom bolus approach for all patients receiving PMRT. This offers uniform distribution of standard radiation doses, thereby minimizing radiation-induced changes while maintaining oncologic safety. We present our 8-year experience with the custom bolus approach for PMRT delivery in immediate autologous breast reconstruction.

methodsAll immediate autologous breast reconstruction patients requiring PMRT after 2006 were treated with the custom bolus approach. Retrospective chart review was performed to compare the postirradiation complications, reconstruction outcomes, and oncologic outcomes of these patients with those of previous patients at our institution who underwent standard bolus, and to historical controls from peer-reviewed literature.

resultsOver the past 10 years, of the 29 patients who received PMRT, 10 were treated with custom bolus. Custom bolus resulted in fewer radiation-induced skin changes and less skin tethering/fibrosis than standard bolus (0% vs 10% and 20% vs 35%, respectively), and less volume loss and contour deformities compared with historical controls (10% vs 22.8% and 10% vs 30.7%, respectively).

conclusionsCustom bolus PMRT minimizes radiation delivery to the internal mammary vessels, anastomoses, and skin; uniformly doses the surgical incision; and provides the necessary radiation dose to prevent recurrence. Because custom bolus PMRT may reduce the deleterious effects of radiation on reconstructive outcomes while maintaining safe oncologic results, we encourage all plastic surgeons to collaborate with radiation oncologists to consider this technique.

Identifiers

PMID28507844
PMCPMC5426863

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.