Women who opt for oncoplastic surgery for early-stage breast cancer are hoping to optimize cosmesis without sacrificing excellent cancer outcomes. Sounds like the ideal case for partial breast irradiation (PBI). Except, logistically, what the heck is the target? By definition, oncoplastic surgery involves “volume displacement or replacement” for cosmetic ends. Here is an excellent review of a wide array of oncoplastic techniques and how adjuvant PBI can or cannot be feasibly incorporated. First of all, oncoplastic surgery is not an absolute contraindication to PBI. The clearest example is when non-malignant breast tissue is removed for size reduction in a location distant from the tumor bed. Otherwise, at minimum, robust clips should be placed along cavity walls, even if adjacent breast tissue is rotated into cavity, and clear communication between surgeon and rad onc is required as pre-op imaging, surgical incisions, and post-op seromas can all be misleading. | Allen, Int J Radiat Oncol Biol Phys 2025
