How do you account for hot/cold spots generated by a metallic port used to inflate tissue expander in breast reconstruction?   

There is dose heterogeneity in the area with 6MV because of port and unless high risk area we accept that. If you have 10MV photons that do decrease dose heterogeneity and some places, use high energy photon with bolus to reduce that uncertainty.Damast et al., PMID 16904530