Interpretation of the CTA for Abdominal Based Flaps in Breast Reconstruction

Introduction

CTA has become the gold standard pre-operative investigation for perforator based breast reconstruction. Existing literature alludes to increased safety of flap harvest, decreased operative raise time, improved flap reliability and decreased fat necrosis. However, a reliable algorithm to use when learning to interpret these images is difficult to find. 

 

Method

A logical and methodical approach to assessment of CTAs has been generated from a personal clinical series of more than 300 flaps over an eight year period.

 

Results

Perforator choice is based on volume of flap required and size and position of available perforators. This algorithm guides the surgeon to the optimal choice of either single or multiple perforator DIEP, SIEA flap or muscle sparing TRAM. Clinical data from this series correlates to a complete flap loss rate of 0.7%, partial flap loss of 0.3% and fat necrosis rate of 2.5%.

 

Conclusions

This approach to CTA assessment can be easily taught and understood and represents a reliable guide to pre-operative imaging.