Advances in imaging technologies for planning breast reconstruction

Area of Science:

• Plastic Surgery
• Radiology
• Surgical Oncology

Background:

• The optimal preoperative imaging for breast reconstruction remains debated, with varying opinions on necessity, modality, cost, and patient outcomes.
• Perforator flaps are increasingly used in microsurgical breast reconstruction due to lower donor site morbidity, durable results, and superior aesthetics, especially post-radiation therapy.
• These complex microsurgical techniques demand precision, making accurate preoperative planning crucial.

Purpose of the Study:

• To review the role and techniques of preoperative imaging in planning breast reconstruction.
• To highlight newer technologies adopted in clinical practice, focusing on computed tomographic angiography (CTA) and magnetic resonance angiography (MRA).
• To emphasize how imaging assists in flap selection and optimizes surgical execution.

Main Methods:

• Review of current literature and clinical practices regarding preoperative imaging in breast reconstruction.
• Discussion of advanced imaging modalities: computed tomographic angiography (CTA), magnetic resonance angiography (MRA), laser-assisted indocyanine green fluorescence angiography (LA-ICGFA), and dynamic infrared thermography (DIRT).
• Specific focus on the application and benefits of CTA and MRA in perforator flap-based breast reconstruction.

Main Results:

• Preoperative imaging provides valuable insights into vascular anatomy and perforator identification, crucial for perforator flap design.
• CTA and MRA can create presurgical maps, highlighting anatomical variations to enhance flap design and intraoperative decision-making.
• These imaging modalities increase predictability and efficiency in flap harvest, potentially improving surgical outcomes.

Conclusions:

• Preoperative imaging, particularly CTA and MRA, plays a vital role in optimizing planning for complex breast reconstruction.
• Accurate vascular mapping through advanced imaging techniques supports safer and more predictable perforator flap harvesting.
• The adoption of these technologies can lead to improved patient outcomes and refine surgical planning in breast reconstruction.