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.
