Identifying perforators in Breast Reconstruction with 3D CT-Scans

The CT-angiogram has shown great utility for DIEP flap, SIEA flap, free TRAM flap, as well as the pedicle TRAM flap in identifying blood supply to the abdominal tissue used in breast reconstruction.

In certain breast reconstruction candidates who have had prior abdominal surgery the CT-angiogram of the abdomen is useful to me not only to plan out the orientation of the flap used in breast reconstruction but also to position the scar on the abdominal wall to facilitate healing.

The illustration below gives an example of a rectus flap planning CT-scan used in breast reconstruction.

Brian P. Dickinson, M.D.
www.drbriandickinson.com

3D CT-Angiogram for Flap Planning in Breast Reconstruction

I have found the CT-angiogram to be very helpful for flap planning in breast reconstruction. The CT-angiogram allows the operative surgeon to have a road map for vessel selection, may facilitate orientation of the flap for breast reconstruction, as well as facilitate positioning of the scar on the abdominal wall for flap harvest.

The CT-angiogram is specifically helpful in the patient who has had previous abdominal operations to determine the integrity of vessels as well as determine which flap may be an appropriate option for the patient such as TRAM, TRAM flap with pre-delay procedure, free TRAM, DIEP, or SIEA.

The 3D reconstruction shown below gives an example of how the surgeon can appropriately evaluate vessel integrity in a previously operated abdomen.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/