ISRM 2014 Organizing Committee. Vessel Selection in Perforator Based Free Flap Breast Reconstruction

Introduction: Successful Breast reconstruction using perforator based flaps pivots on a proper selection of donor and recipient vessels, and the volume of tissues these vessels can support.

Pre operative localization of perforators using CT angiograms and duplex scans allow for a better localization, with reduced operating time.

Methodology and Material: Twenty two consecutive patients undergoing immediate breast reconstruction were investigated for their perforator anatomy using CT Angiograms.

• The superficial inferior epigastric and deep inferior epigastric system were studied.

• Internal Mammary system and its perforators were also studied

CT scans of 10 patients (for other causes) were also studied to dilienate the perforator anatomy of the internal mammary system.

Results: In the 22 patients

The perforators from the DIEP were localized preoperatively around a 6 cm circle localized in the lower abdomen, the umbilicus lying within 2cms below the cranial line. Major perforators arose from the medial chain. On an average 2-4 perofrators could be identified on either side, but they did not form a mirror image.

The SIEA system was found dominant in 8 patients and was seen communicating with the DIEP perforators.

The Internal Mammary perforators usually arose from the 2nd and 3rd space and had a toruous course with a diameter averaging 1 mm in 52%.

Conclusions: CT angiographic localization of the lower abdomen and internal mammary system allows for clear operative planning, and selection of side, donor and recipient system.