8.0: Thursday, March 17, 2005

The Use Of CT Angiography In Free Flap Breast Reconstruction

Eric Chang, MD, James Chang, J.C. Hellinger, Geoffrey D. Rubin, and Yvonne L. Karanas.

Autologous breast reconstruction by free microsurgical transfer necessitates adequate recipient vessels. The internal mammary and thoracodorsal vessels are the most commonly used vessels. Previous surgery and radiation therapy may render these vessels unsuitable for microvascular anastomosis. This study evaluated the usefulness of CT angiography in guiding preoperative planning for patients who had undergone previous surgery.

Five patients underwent breast reconstruction by free-tissue transfer after having previous breast surgery with axillary node dissection. Three of these patients had previous radiation therapy to the chest and axilla. The thoracodorsal vessels were evaluated by CT angiography and felt to be suitable as recipient vessels in two patients. In two of the remaining patients, the internal mammary vessels were deemed adequate recipient vessels. The final patient had a poorly visualized internal mammary vein and was deemed a poor candidate for free tissue transfer.

CT angiography is a relatively easy and safe imaging modality which can help determine the adequacy of recipient vessels for free tissue transfer. The patency and size of thoracodorsal and internal mammary vessels can be evaluated by a single study. Target recipient vessels for microsurgical transfer can be determined preoperatively, and operative dissection of nonusable axillary vessels can be avoided.