If treating a patient with prior breast augmentation with whole breast radiation, would you alter your field setup?

With prior breast augmentation, I think you have a few options.

1. Whole breast irradiation with tangents - I typically cover the entire chest wall and don't move the field edge forward. With respiratory motion (unless using DIBH or other respiratory techniques), I do worry about missing areas at risk with moving the posterior border anteriorly. I often have the patient see plastics and we discuss changing implants out down the road.
2. Partial breast irradiation - I have done partial breast irradiation in cases like this using a 40 Gy/15 fraction IMPORT LOW approach.
3. Exchange implant for expander at the time of surgery - not often in my experience but sometimes done. In these cases, I treat standard tangent fields.

Gebhardt et al., PMID 28939351

In general, I believe the key is continuing to make sure that you are covering your entire target, which includes the area behind the implant (in whole breast radiation). I would not cover only the breast tissue anterior to the implant in the whole breast setting. Field arrangement should be performed to encompass this region. The contralateral breast anatomy may prove challenging when designing your field arrangement.