Incidental Findings in CT and MR Angiography for Preoperative Planning in DIEP Flap Breast Reconstruction
Background:. Autologous breast reconstruction with deep inferior epigastric perforator flaps is considered a standard of care in the treatment after mastectomy, yet vascular anatomy is highly variable and perforator selection remains challenging. The use of preoperative imaging can influence surgica...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2020-10-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003159 |
| _version_ | 1819076544550666240 |
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| author | Ryan D. Wagner, MD Andres F. Doval, MD Nikhilesh V. Mehra Hung B. Le Paul A. Niziol, BS Warren A. Ellsworth, MD Aldona J. Spiegel, MD |
| author_facet | Ryan D. Wagner, MD Andres F. Doval, MD Nikhilesh V. Mehra Hung B. Le Paul A. Niziol, BS Warren A. Ellsworth, MD Aldona J. Spiegel, MD |
| author_sort | Ryan D. Wagner, MD |
| collection | DOAJ |
| description | Background:. Autologous breast reconstruction with deep inferior epigastric perforator flaps is considered a standard of care in the treatment after mastectomy, yet vascular anatomy is highly variable and perforator selection remains challenging. The use of preoperative imaging can influence surgical planning and assist intraoperative decision-making. However, this imaging can inevitably uncover incidental findings. The purpose of this study was to analyze incidental findings, evaluate correlation with patient factors, and examine effects on overall care.
Methods:. A retrospective review was performed on 350 consecutive patients who received magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) as a preoperative evaluation for deep inferior epigastric perforator flap breast reconstructions done between August 2015 and June 2019. Radiology reports were analyzed for incidental findings. Patient charts were reviewed for patient history, genetic history, cancer treatment, and type of reconstruction.
Results:. Of the 350 patients meeting the criteria, 56.9% were noted to have incidental findings on preoperative imaging, 12.9% received additional imaging, and 4.0% underwent additional interventions. There was no difference in the percentage of patients with incidental findings between immediate and delayed reconstructions or between CTA and MRA. Five patients were found to have malignancies.
Conclusions:. Preoperative CTA and MRA is a valuable tool to optimize outcomes and efficiency in breast reconstruction with abdominal perforator flaps. However, this imaging can also be beneficial to the overall wellness of the patient. With the high prevalence of incidental findings on preoperative imaging, it is important to counsel patients and adjust surgical plans, if necessary. |
| first_indexed | 2024-12-21T18:43:00Z |
| format | Article |
| id | doaj.art-4b145b7f09b845d0990f2f2211ec1c0d |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-21T18:43:00Z |
| publishDate | 2020-10-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-4b145b7f09b845d0990f2f2211ec1c0d2022-12-21T18:53:57ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742020-10-01810e315910.1097/GOX.0000000000003159202010000-00004Incidental Findings in CT and MR Angiography for Preoperative Planning in DIEP Flap Breast ReconstructionRyan D. Wagner, MD0Andres F. Doval, MD1Nikhilesh V. Mehra2Hung B. Le3Paul A. Niziol, BS4Warren A. Ellsworth, MD5Aldona J. Spiegel, MD6From the * Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Tex.† Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Tex.‡ Undergraduate Student, University of Texas at Austin, Austin, Tex.‡ Undergraduate Student, University of Texas at Austin, Austin, Tex.† Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Tex.† Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Tex.† Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Tex.Background:. Autologous breast reconstruction with deep inferior epigastric perforator flaps is considered a standard of care in the treatment after mastectomy, yet vascular anatomy is highly variable and perforator selection remains challenging. The use of preoperative imaging can influence surgical planning and assist intraoperative decision-making. However, this imaging can inevitably uncover incidental findings. The purpose of this study was to analyze incidental findings, evaluate correlation with patient factors, and examine effects on overall care. Methods:. A retrospective review was performed on 350 consecutive patients who received magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) as a preoperative evaluation for deep inferior epigastric perforator flap breast reconstructions done between August 2015 and June 2019. Radiology reports were analyzed for incidental findings. Patient charts were reviewed for patient history, genetic history, cancer treatment, and type of reconstruction. Results:. Of the 350 patients meeting the criteria, 56.9% were noted to have incidental findings on preoperative imaging, 12.9% received additional imaging, and 4.0% underwent additional interventions. There was no difference in the percentage of patients with incidental findings between immediate and delayed reconstructions or between CTA and MRA. Five patients were found to have malignancies. Conclusions:. Preoperative CTA and MRA is a valuable tool to optimize outcomes and efficiency in breast reconstruction with abdominal perforator flaps. However, this imaging can also be beneficial to the overall wellness of the patient. With the high prevalence of incidental findings on preoperative imaging, it is important to counsel patients and adjust surgical plans, if necessary.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003159 |
| spellingShingle | Ryan D. Wagner, MD Andres F. Doval, MD Nikhilesh V. Mehra Hung B. Le Paul A. Niziol, BS Warren A. Ellsworth, MD Aldona J. Spiegel, MD Incidental Findings in CT and MR Angiography for Preoperative Planning in DIEP Flap Breast Reconstruction Plastic and Reconstructive Surgery, Global Open |
| title | Incidental Findings in CT and MR Angiography for Preoperative Planning in DIEP Flap Breast Reconstruction |
| title_full | Incidental Findings in CT and MR Angiography for Preoperative Planning in DIEP Flap Breast Reconstruction |
| title_fullStr | Incidental Findings in CT and MR Angiography for Preoperative Planning in DIEP Flap Breast Reconstruction |
| title_full_unstemmed | Incidental Findings in CT and MR Angiography for Preoperative Planning in DIEP Flap Breast Reconstruction |
| title_short | Incidental Findings in CT and MR Angiography for Preoperative Planning in DIEP Flap Breast Reconstruction |
| title_sort | incidental findings in ct and mr angiography for preoperative planning in diep flap breast reconstruction |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003159 |
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