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If you’re receiving radiation therapy for breast cancer after a mastectomy, your care team may place a wet towel or another material over the treatment area. This is called a bolus, and it helps increase the amount of radiation that reaches the skin and can help even out an irregular surface.
One MyBCTeam member described their experience. “I started radiation this week, and they told me every other day they will put a wet towel over my breast to increase the effect of radiation,” they said. “Has anyone else had this done?”
If your treatment plan includes a bolus, understanding why it’s used and what to expect can help you feel more prepared for radiation therapy.
After a mastectomy, a bolus may be used to deliver a higher radiation dose to the skin and tissues near the surface. A bolus may be recommended during postmastectomy radiation therapy in certain cases, including:
Some people with breast cancer have a higher risk of local recurrence, which means the cancer cells may come back in or near the first area treated. After a mastectomy, recurrence can occur in the skin or chest wall.
Radiation therapy usually delivers a lower dose at the skin surface than to tissue below it. A bolus adds a layer over the skin, which helps bring more of the radiation dose closer to the surface.
A bolus in radiation therapy can also help account for irregularities in the skin or chest wall, such as uneven areas caused by surgical scars. This can help radiation reach the areas near the skin that need treatment more evenly.
“When they radiated my left chest expander, they radiated 3 inches above and 3 inches below to make sure they got any residual cancer cells. They also used a bolus every other day. They placed a wet towel over my entire breast and then radiated it. I sure hope that was enough not to have a recurrence,” a MyBCTeam member said.
A bolus can be made from various materials, including:
A wet towel or wet gauze is sometimes used as a lower-cost alternative to other types of boluses. The thickness of a bolus can vary depending on the treatment plan.
Researchers are also studying 3D printing to create customized boluses based on a person’s imaging scans. These personalized boluses are designed to fit the treatment area closely and help deliver radiation more precisely.
A bolus is designed to increase the radiation dose to the skin, so using one can raise the risk of skin reactions — also known as skin toxicity or radiodermatitis. Side effects from radiation with a bolus may include:
Bolus radiotherapy for breast cancer is individualized based on your needs, including how often a bolus is used and its thickness.
MyBCTeam members have expressed concern about skin reactions with a bolus. “Just finished the first week (five sessions) of radiation. So far so good, but I know the side effects come later,” one member said. “They used a bolus, which worries me a little since it increases toxicity in the skin. I’ll discuss it with my radiation oncologist on Monday.”
“Rads are difficult. I had 25 rounds — 13 with a bolus and 12 without. My skin turned black with green hues,” shared a member. “Burn is still healing. It’s itchy and red. All the blackness is gone and has moved into a red, bumpy phase. And yes, the surgeon was correct — it’s getting better.”
Skin side effects may gradually improve after radiation treatment ends, but some changes may last longer. “I did 28 treatments,” a member wrote. “They radiated my entire breast and lymph nodes. The worst part was when they did the bolus treatments using a wet towel over my entire breast area and radiated through the towel. I still have burning six months later.”
If your doctor recommends radiation with a bolus, ask what side effects to expect. Some side effects may be caused by radiation rather than the bolus. Talk with your care team about recovery, follow-up visits, and any side effects that don’t improve.
If you experience skin changes or reactions from radiation treatment with a bolus, you can take steps to manage side effects. Ask your healthcare team which products are safe to use on treated skin. Here are some skin care tips to help protect your skin during radiation therapy:
Some lotions, creams, ointments, deodorants, and perfumes may irritate already-sensitive skin. Your cancer care team can recommend topical skin products that are appropriate during and after radiation treatment.
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Why would the radiation team allow the skin to turn black and burn so badly? I don’t think that is healthy at all.
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My therapy included the use of the Bolus. It was placed over the mastectomy area then tucked under the armpit and covered from my neck to beyond my waist. The therapist always warmed the bolus (half… read more
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