Preoperative computed tomographic angiography of both donor and recipient sites for microsurgical breast reconstruction

Abstract

Background: Computed tomographic angiography is widely used for obtaining vascular information about the abdominal donor site for microsurgical breast reconstruction. The purpose of this study is to report the authors' experience using preoperative computed tomographic angiography of both donor and recipient sites for a series of microsurgical breast reconstruction procedures.

Methods: A total of 71 patients preparing for autologous breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps underwent preoperative computed tomographic angiography with scanned fields ranging from the clavicle to the pubic symphysis. Preoperative evaluation included computed tomography-based anatomy of the intercostal space, the internal mammary artery and vein, and the internal mammary artery perforator to determine which intercostal space was to be approached. The volume of the breast and the volume of the abdominal flap were calculated using computed tomography-based volumetry.

Results: In 67 patients, the internal mammary vessel was exposed expeditiously at the preoperatively designated intercostal space by the rib-sparing technique. The design of flaps, including vascular pedicles, was accomplished with the aid of the computed tomography-based volumetric ratio (mean, 0.64) between the breast and abdominal flaps of patients. The volumetric ratio ultimately correlated with the ratio of the weight of the actual flap inset to the harvested flap weight (mean, 0.63).

Conclusions: Preoperative computed tomographic angiography of both donor and recipient sites provides valuable information for planning and executing microsurgical breast reconstruction. Computed tomography-based anatomy and volumetry facilitate the approach to recipient vessels and harvest of free DIEP flaps.

Clinical question/level of evidence: Diagnostic, IV.