How do you treat the chest wall after mastectomy with an expander?

We have not been treating patients with immediate tissue expander reconstruction with hypofractionated photon post-mastectomy radiotherapy off trial. However, we are excited to be opening @Dr. First Last's A221505 randomized photon study. In addition, we are nearing completion of enrollment to NCT02...

https://www.ncbi.nlm.nih.gov/pubmed/26383675

This paper from us shows recurrence pattern and highlights the importance of revising contouring for the chest wall as the area of risk is above the pec and in between pec muscle.

It is not behind and not into intercostal muscle as required in current guide...

I treat it much like I would for a non-reconstructed chest wall, with every other day bolus. Instead of superflab bolus, however, we use chain mail which is equivalent to 0.5cm of superflab bolus. It conforms to the tissue expander better.

I strongly prefer to only use hypofractionated radiation aft...

I feel there is place for use of hypofrationation after mastectomy with or without expander. It will be nice to see clinical trials completed to confirm this.