L. M. Ngaage1,2, D. Ghorra3, G. Oni3, B. C. Koo4, J. Ang2, S. L. Benyon3, M. S. Irwin3, C. M. Malata3,5,6 1Imperial College Trust,Foundation School,London, ENGLAND, United Kingdom 2University of Cambridge,School Of Clinical Medicine,Cambridge, ENGLAND, United Kingdom 3Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust,Department Of Plastic & Reconstructive Surgery,Cambridge, ENGLAND, United Kingdom 4Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust,Department Of Radiology,Cambridge, ENGLAND, United Kingdom 5Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust,Cambridge Breast Unit,Cambridge, ENGLAND, United Kingdom 6Anglia Ruskin University,School Of Medicine,Chelmsford & Cambridge, ENGLAND, United Kingdom
Introduction:
Preoperative CT angiography (CTA) of the abdominal wall vessels is routinely used when planning free flap breast reconstruction (FFBR) because it provides a surgical roadmap, which facilitates flap harvest. However, there are few reports on the effect of incidental findings on the operative plan.
Methods:
A retrospective study of all FFBRs performed at a tertiary referral centre for breast reconstruction over a six-year period (November 2011 to June 2017) was conducted. One consultant radiologist (BCK) reported on the findings. Details on patient demographics, CTA reports, and intraoperative details were collected.
Results:
200 patients received preoperative CTAs. 14% of patients (n=28) had incidental findings. Of the incidental findings, 18% were vascular anomalies; 36% tumour-related and 46% were “other”. In four patients, findings were severe enough to prevent surgery. They comprised of mesenteric artery aneurysm, absent DIEVs due to previous surgery, bilateral occluded DIEAs, and significant bone metastasis. Another patient had no suitable vessels for a free flap and the surgical plan converted to a pedicled TRAM flap. The remaining incidental findings had no impact on the surgical plan or appropriateness of a free flap breast reconstruction. Nearly a quarter of those with incidental findings went on to have further imaging before their operation.
Conclusion:
CTA in breast reconstruction can have a wider impact than facilitating surgical planning and reducing operative times. Incidental findings can influence the surgical plan, and in some instances, avoid doomed to fail and unsafe surgery. It is important that these scans are reported by an experienced interventional radiologist.