Sanjay Mehta, M.D.

Explain to folks what expanders are, how that works surgically. So essentially what's happening is when you have a full mastectomy, if a patient wants to have their breast reconstructed later on,

Explain to folks what expanders are, how that works surgically. So essentially what's happening is when you have a full mastectomy, if a patient wants to have their breast reconstructed later on,

The breast surgeon will remove the breast, but then the plastic surgeon will come in and place some sort of a placeholder to allow the soft tissue and all the connective tissue and the skin to stretch to allow for future implant placement. And so those tissue expanders, they can actually inject saline into them with a port and gradually stretch them with time.

The breast surgeon will remove the breast, but then the plastic surgeon will come in and place some sort of a placeholder to allow the soft tissue and all the connective tissue and the skin to stretch to allow for future implant placement. And so those tissue expanders, they can actually inject saline into them with a port and gradually stretch them with time.

That's normally what they would do if there was no radiation involved. Again, most mastectomy patients really don't need radiation because this gets away from what we mentioned earlier where breast conservation is lumpectomy only. But there are some patients with a full mastectomy who are going to get reconstructed. So they come to me when I do their CT scan.

That's normally what they would do if there was no radiation involved. Again, most mastectomy patients really don't need radiation because this gets away from what we mentioned earlier where breast conservation is lumpectomy only. But there are some patients with a full mastectomy who are going to get reconstructed. So they come to me when I do their CT scan.

They have this expander in place from the breast surgeon. So we have to, again, modulate the beams and we treat the entire chest while we make sure we're covering everything.

They have this expander in place from the breast surgeon. So we have to, again, modulate the beams and we treat the entire chest while we make sure we're covering everything.

But simultaneously, we have to make sure that we don't have those hot spots in the area of the expander where potentially you could cause scarring and fibrosis and cause the expander to have to be removed, have the plastic surgeon have to revise it. That becomes a whole nother hill of beans there that we don't like to mess with. But we have techniques now to be able to keep the dose off of them.

But simultaneously, we have to make sure that we don't have those hot spots in the area of the expander where potentially you could cause scarring and fibrosis and cause the expander to have to be removed, have the plastic surgeon have to revise it. That becomes a whole nother hill of beans there that we don't like to mess with. But we have techniques now to be able to keep the dose off of them.

And again, as you mentioned earlier, whether it's silicone or saline, it's roughly the same density. But some of these tissue expanders have bits of metal in them. They may have other artifacts. And so when I'm treating with photons, with x-rays, depending on what you're hitting, the effect is based on the density, the atomic number of that tissue. So metal behaves very differently.

And again, as you mentioned earlier, whether it's silicone or saline, it's roughly the same density. But some of these tissue expanders have bits of metal in them. They may have other artifacts. And so when I'm treating with photons, with x-rays, depending on what you're hitting, the effect is based on the density, the atomic number of that tissue. So metal behaves very differently.

Bone behaves differently from air, but when you're in the spectrum of saline, tissue, water, it's all basically the same. We can model all that very much like, I'm getting ahead of myself, but very much like when we have a prostate patient with a prosthetic hip, a piece of metal right next door, we're able to compensate for that with the modern computer treatment planning systems.

Bone behaves differently from air, but when you're in the spectrum of saline, tissue, water, it's all basically the same. We can model all that very much like, I'm getting ahead of myself, but very much like when we have a prostate patient with a prosthetic hip, a piece of metal right next door, we're able to compensate for that with the modern computer treatment planning systems.

Not at all. The only time we see radiation patients who have nausea or vomiting, it's a lot of times for other sites, they may get concurrent chemo radiation where the chemo could be responsible. But for breasts, we don't do concurrence, usually sequential.

Not at all. The only time we see radiation patients who have nausea or vomiting, it's a lot of times for other sites, they may get concurrent chemo radiation where the chemo could be responsible. But for breasts, we don't do concurrence, usually sequential.

The only time I really see radiation-induced nausea is if I'm treating an esophagus or a pancreas or something that's treating in the abdomen or somewhere along the GI tract where nausea is more of an issue, typically not for breasts.

The only time I really see radiation-induced nausea is if I'm treating an esophagus or a pancreas or something that's treating in the abdomen or somewhere along the GI tract where nausea is more of an issue, typically not for breasts.

The answer to that has been evolving. There was a time as recently as probably 20 years ago where we only treated patients who were probably medically inoperable that the urologist would say, hey, you know, this is a high-risk anesthesia patient. Let's send them to Dr. Mehta for radiation.

The answer to that has been evolving. There was a time as recently as probably 20 years ago where we only treated patients who were probably medically inoperable that the urologist would say, hey, you know, this is a high-risk anesthesia patient. Let's send them to Dr. Mehta for radiation.