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The authors declare that they have no competing interests.
All of the authors have made substantial contributions to conception and design, and/or acquisition of data or analysis and interpretation of data. BCO conceived of the study, and along with EG participated in its design and coordination. IA, GK and BS planned and carried out the radiotherapy process. VO and MST performed the histopathologic examination. BT, ABK and AA helped interpret the findings and draft the manuscript. All authors read and approved the final manuscript.
The optimum protocol for expander volume adjustment with respect to the timing and application of radiotherapy remains controversial.
Eighteen New Zealand rabbits were divided into three groups. Metallic port integrated anatomic breast expanders of 250 cc were implanted on the back of each animal and controlled expansion was performed. Group I underwent radiotherapy with full expanders while in Group II, expanders were partially deflated immediately prior to radiotherapy. Control group did not receive radiotherapy.
The changes in blood flow at different volume adjustments were investigated in Group II by laser Doppler flowmetry. Variations in the histopathologic properties of the irradiated tissues including the skin, capsule and the pocket floor, were compared in the biopsy specimens taken from different locations in each group.
A significant increase in skin blood flow was detected in Group II with partial expander deflation. Overall, histopathologic exam revealed aggravated findings of chronic radiodermatitis (epidermal atrophy, dermal inflammation and fibrosis, neovascularisation and vascular changes as well as increased capsule thickness) especially around the lower expander pole, in Group II.
Expander deflation immediately prior to radiotherapy, may augment the adverse effects, especially in the lower expander pole, possibly via enhanced radiosensitization due to a relative increase in the blood flow and tissue oxygenation.