How do you deliver whole breast radiation to a woman with pectus excavatum?

Agree that these can be challenging cases. The technique used depends on the severity of the pectus deformity, need to treat regional nodes (particularly IMNs), and need to treat the whole breast.

@Dr. First Last's advice is sound regarding multiple different plans may be needed and then the optimal ...

I agree with @Dr. First Last's comments; these can be very challenging cases even when internal mammary lymph nodes don't need to be covered. With significant posterior depression of the sternum in pectus excavatum, the resultant anatomy can make it difficult to limit dose to the contralateral breas...

These are extremely challenging cases particularly if internal mammary nodes need to be covered.

Prone and breath hold may help but with left sided cases the heart may actually stay relatively close to chest wall. In terms of fields, tangents don’t work well usually but can try electron photon match...