What is your approach for PMRT when the patient has a DIEP flap?

I would say that the presence of a DIEP flap does not change my approach to PMRT much. I look to cover the chest wall and regional nodes (+/- IM nodes) similar to a flat chest wall or expander/implant case. In my experience, the only change that sometimes happens is planning as the DIEP can sometime...

There is concern that radiation can affect internal mammary and DIEP flap anastomosis, but I'm not sure what the exact risk would be. I also only cover IMN selectively, so when I need to cover it, the patient is high risk. Our institution is fortunate to have plastic surgeons who understand cancer c...