Dosimetric analysis of radiation dose to latissimus dorsi myocutaneous flap in women undergoing adjuvant radiotherapy for early breast cancer-short report: Radiation dose to latissimus dorsi myocutaneous flap

Kevin Albuquerque, David Sieber, Matthew Hiro, Hajirah Saeed, Greg Surfield, Vidya Shankaran, Victor Cimino

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Breast reconstruction following mastectomy often involves the use of regional myocutaneous flaps such as the latissimus dorsi (LDM) and transverse rectus abdominus flaps. A history of previous radiation to the skin paddle of the myocutaneous flap planned for breast reconstruction may cause the plastic surgeon to consider using an alternative muscle flap which has not received radiation. To aid decision-making in the setting of previous radiation, we prospectively assessed the dose given to the latissimus myocutaneous flap of a small series of seven women who were to undergo adjuvant 3-D conformal radiation therapy after breast conservation surgery (four) or mastectomy (three). The skin paddles of this flap were marked using wires prior to the planning CT scan required for 3-D conformal therapy. Radiation dose to the skin paddles was minimal but the LD muscle dose averaged 888 cGy. The thoracodorsal artery received the highest doses of radiation averaging 2,750 cGy with 55.5% of the artery receiving at least 2,500 cGy and 25.3% of the artery receiving at least 4,500 cGy which was almost a prescription radiation dose to the whole breast. The clinical implications of this level of radiation dose to the arterial pedicle are likely minimal because it is a peripheral small blood vessel. The surgeon and the radiation oncologist should be aware of this as a potential factor and its possible effects on breast reconstruction outcome particularly in the midst of other predictors of poor vascularity such as smoking, diabetes, or peripheral vascular disease. We plan to study further the dose to LDM flap in a larger series of women. However, information about dose to planned myocutaneous flap in the setting of history of previous breast radiation can be easily obtained from the radiation plan and should be ascertained prior to breast reconstruction.

Original languageEnglish (US)
Pages (from-to)271-275
Number of pages5
JournalEuropean Journal of Plastic Surgery
Volume33
Issue number5
DOIs
StatePublished - Oct 1 2010

Keywords

  • Breast cancer
  • Breast reconstruction
  • Myocutaneous flap
  • Radiation dose

ASJC Scopus subject areas

  • Surgery

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