Preoperative CT-angiography in autologous breast reconstruction

CT-angiography (CTA) has been introduced as a means of evaluating arterial anatomy and vascular integrity prior to free autologous breast reconstruction. There is limited published data, however, regarding the incidence, indications, and impact of preoperative CTA (pCTA) on procedural and flap outcomes.

Retrospective review was performed of all autologous microsurgical breast reconstruction procedures at a single academic center between January 2004 and July 2014. Univariate analysis of patient, procedural, and flap characteristics was performed and a logistic regression model was configured to assess for factors associated with ischemia-related complications.

There were 1,110 microsurgical flap reconstructions performed in 778 patients by 3 surgeons at our institution during the study period. Overall, 11.4% of patients underwent pCTA; frequency increased from 0 to 35.7%. Patients who underwent pCTA had significantly higher body mass index (P = 0.041), and more coronary artery disease (P = 0.022), prior abdominal surgery (P = 0.004), and bilateral reconstruction (P = 0.015). No statistically significant difference between groups was found with respect to flap characteristics or operative time. Multivariate analysis revealed that although pCTA was associated with a lower incidence of ischemia-related complications (complete or partial flap loss or fat necrosis) (OR, 0.57, 95% CI, 0.32 to 1.02), this did not reach statistical significance (P = 0.058).

Use of pCTA has increased dramatically at our institution since it was first incorporated into the reconstructive surgical planning process in 2008. Given the expense, radiation exposure, and borderline impact on ischemia-related flap complications, surgeons should selectively consider pCTA as an adjunct to their surgical planning algorithm. © 2015 Wiley Periodicals, Inc. Microsurgery 36:623-627, 2016.