Postmastectomy Radiation Modalities (Protons, Chest Wall Boost, Skin Bolus, Fractionation, and Timing) and Breast Reconstruction Complications: The Role of Radiation Oncologist

Purpose of ReviewIntegrating postmastectomy radiotherapy (PMRT) and breast reconstruction remains a multidisciplinary clinical challenge. While PMRT improves tumor outcomes in patients with locally advanced breast cancers, it increases breast reconstruction complications. Therefore, understanding the nuances of different surgical and PMRT techniques and their dynamic interaction is crucial to overcome such challenge.Recent FindingsIntroduction of new reconstruction techniques including single-stage implant reconstruction, different types of surgical mesh and pre-pectoral implants placement, allowed different approaches for the caregivers and patients. In parallel to this surgical progress, there were PMRT advances such as intensity-modulated radiotherapy (IMRT), protons, different types of skin bolus, and more knowledge about usage of chest wall boost.In this review article, we discuss the different surgical and PMRT advances through a comprehensive literature review. We also discuss personalized approach to this problem using machine learning nomograms and risk score calculators.