Do you use bolus for the lumpectomy cavity boost when the seroma is within 5mm of the skin?  

I agree with the above that this is very rarely necessary. When it is required, it may be hard to define where the bolus is to be placed on an intact breast. One neat trick is to have dosimetry create an en face setup field with an aperture equivalent to where you want the bolus to be (cavity plus m...

I typically would not unless there was significant concern for the skin margin (hopefully would have been excised). I worry about the skin toxicity and wound healing issues, and the area is already getting boost anyway. 

I use localized bolus when seroma is up to the skin to cover anterior margin.

I will use a small area of bolus if cavity is close to the surface to ensure the cavity is getting adequate dose from the whole breast fields. This is less necessary when using 6 MV photons but in cases where mixed energies or higher energies are needed there can be substantial drop in dose for sup...

I wouldn’t do it normally. The skin margin is probably the most difficult margin to assess. If the surgeon used cautery, the margin is bigger than reported. If cautery is used, you could have breakdown (happened in 1 patient with diabetes). Many patients probably don’t need a boost. I ha...