REPOSITIONING AND IMMOBILIZING THE BREAST WITH ALPHA CRADLE® DEVICES

Jeffrey Vincent Kostich,President
Smithers Medical Products, Inc.
North Canton, Ohio 44720

One of the most difficult repositioning challenges offered to the medical professional is the successful repositioning and immobilization of the breast. A large flaccid breast offers the greatest challenge for successful replication of the desired set-up position. Smithers Medical Products, Inc. has developed a new tool that can be used to hold the breast in the desired position during treatment. This new device, the Bravelle™ is a device consisting of a reinforced ring that is secured to the patient’s breast through the utilization of Velcro straps. Large pendulous breasts can be supported within the ring with an elliptical piece of polystyrene fabricated by the user. The Bravelle™ keeps the breast from falling laterally during treatment and more importantly helps reduce the amount of lung that may be treated by keeping the breast up on the chest wall. This device makes it possible to treat breast cancer patients that otherwise would not be candidates for radiation therapy due to the enormous technical difficulties they present.

ALPHA CRADLE® BRAND PATIENT REPOSITIONING SYSTEMS:
BF1, BF2R, BF2L, BF3R, BF3L, BF4R, BF4L, BF4R-E, BF4L-E, HS2M, HS2M-E, HS2-E

No less than 12 different ALPHA CRADLE® brand immobilization devices have been developed over the past 10 years for the successful treatment of carcinoma of the breast. Each of these devices offers its own unique characteristic to customized forms.
Together, when used with the Bravelle™, our customized repositioning devices offer the medical professional the most current state-of-the-art technology to successfully immobilize and reposition the patient on a daily basis.
The current trend in the industry for successful immobilization and repositioning of the breast involves the utilization of the Bravelle™ with the newly extended breast devices. The Bravelle™ allows the treated breast to be set up daily in the same position, while the extended breast device, BF4E, controls rotation and eliminates unnecessary movement of the anatomy.
To maximize the efficiency of the extended forms, great care must be given in maintaining a tight fitting form during the fabrication process. It is recommended that 2-3 people work together to maintain the integrity of the form during the foaming process. By placing your hands firmly against the foam as it begins to harden, you will create a tight fitting form that will not allow deviations or movements of the patient’s anatomy. It is also critical that the patient remains completely motionless throughout the fabrication process. Talking, by the patient, should be eliminated or greatly restricted. When the foam begins to rise, it will lift the patient’s head and extremities. As the foam begins to turn to a spongy consistency, carefully push the head and extremities back, deep into the form. Next, push the foam tightly against the patient’s skin. This will create a deep, tight form that will truly hold your patient still throughout the treatment course.
Ports should be cut carefully after the completion of the fabrication process. Ports can easily be cut with a serrated knife, or with a hacksaw blade. Ports should only be cut as necessary, and only as wide as absolutely needed. After the port has been cut, a damp washcloth should be used to wipe out any foam residue that may have fallen into the cradle. Next, the cut area should be covered completely with a cloth or paper tape. This will guarantee that the patient’s skin doesn’t come in contact with the foam material, which can act as an irritant if contacted with skin.
It is important to index the form according to the position of the form with your positioning lasers. This will allow you to reposition the form on the treatment couch before placing your patient in the form. The patient’s arms should fit deep inside the groove you created in the fabrication process. If a patient has large flabby arms, a small series of tattoos can be placed on the arm where it makes contact with the cradle. This will permit you to duplicate the rotation of the patient’s skin to the relative position of the cradle when they are inside.

ACMMII
The ACMMII offers the maximum customization in the fabrication of breast devices. The best means of immobilization and repositioning is achieved when used with the Bravelle™. Devices can be made from the top of the patient’s hips. Because the ACMMII offers a hands on approach, foam can be diverted from areas where ports may be desired to areas where maximum support is needed. The first helpful hint to making firm, supportive forms is to cut a ½” to 1” thick piece of polystyrene 8” wide and 12” long. This will serve as a base support for the form when placed inside of the bag. The foam will stick to the sides of the base making a strong, almost indestructible form. By placing the base piece inside, this will allow more foam to be used along the sides of the form, extending it to the patient’s hips. This offers the maximum control of patient rotation.
Unroll the bag of foam that is underneath the patient’s raised arm during the fabrication process. Work the foam into this area and then carefully wrap the bag along the base and sides of the arm. Next, cut pieces of tape and affix them to the bag against the patient’s skin. This will allow the foam to rise up and around 2/3 of the patient’s arm, making a deep and secure groove for the arm.
If the patient is not able to place their arm flat against the ACMMII board, due to surgery or extreme discomfort, the form can be built up off the board. Place the empty bottle #1 underneath (not inside) the bag of foam. Using the dividers, make a tight fitting guide for the arm support. Use tape as necessary to keep the bag of foam against the patient’s skin. This will allow you to create a customized arm support that reaches up and off the treatment couch, yet securely and comfortably holds the patient’s arm in the desired set-up position.