Preoperative Computed Tomographic Angiogram for Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Abstract

Precision in preoperative evaluation of the abdominal wall vascular anatomy is of utmost importance in successful planning and execution of perforator flap surgery for breast reconstruction after mastectomy. We performed a study in 357 patients scheduled for deep inferior epigastric artery perforator (DIEAP) flap breast reconstruction to review our 5-year experience with the technique we developed based on our previous research confirming accuracy of a computed tomographic (CT) angiogram (multidetector row computed tomography [MDCT]) in preoperative planning of abdominal perforator flap surgery. Images obtained from the radiological study were used to create an accurate map of dominant abdominal perforators of the deep inferior epigastric artery, showing their location, size, and anatomic considerations of relevance for the preoperative flap design. Anatomic dissection of all perforators was performed in the first 36 cases to compare the data with preoperative MDCT findings. In the following 321 patients, the dominant perforator was chosen solely on the basis of MDCT and dissected directly. Exact correlation between surgical and radiological results was found in the first 36 cases. A significant reduction in average operating time and postoperative complications was noted in the following 321 patients. CT angiogram provides important preoperative information on inferior abdominal wall vascular anatomy, facilitating DIEAP flap harvest, saving operative time, and reducing complications and costs. It proved to be an invaluable tool in the preoperative algorithm for DIEAP flap breast reconstruction.