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Abstract #4465

Pre-Operative Perforator Flap MRA for Autologous Breast Reconstruction

Nanda Deepa Thimmappa1, Silvina P. Dutruel1, Mengchao Pei1, Joshua L. Levine2, Julie Vasile3, David Greenspun3, Constance Chen3, Christina Rhode4, Christina Y. Ahn5, Robert Allen3, Martin R. Prince1

1Radiology, Weill Cornell Medical College, New York, NY, United States; 2Plastic surgery, The Center for the Advancement of Breast Reconstruction at NYEE, New York, NY, United States; 3Plastic & Reconstructive Surgery, New York, NY, United States; 4NewYork-Presbyterian Hospital/Columbia, New York, NY, United States; 5Plastic surgery, NYU Langone Medical Center, New York, NY, United States

This retrospective analysis explores the accuracy of MRA mapping of perforator vessels for autologous breast reconstruction finding MRA to be accurate within 1 cm in all 107 patients. With pre-operative MRA, the flap necrosis rate decreased to 3% compared to an historical average of 14% in the literature. Importantly MR also detected occult metastatic disease in 4 patients. Finally, an automated method of calculating perforator coordinates is presented which eliminated typographical errors associated with manual reporting.

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Keywords

abdomen accuracy accurately advent allowed among anesthesia angiography arterial arteries artery audience automated available awaiting axial bandwidth bilateral body breast bundle buttock calculation caliber candidate cocoa college complications constance contra coordinates correlate correlated course created deep discovered disease dissection distances easier enhancement entry errors experience favorable favorably findings flap flaps flex flexibility graft harvest harvested homogeneity improved included increasing inferior initial internal issues language lava literature longer mammary manual manually maps mastectomy matrix maximal medical metastases metastatic months natural necrosis noted noticed objective operating operative ordinates outcomes patients physicists plastic popular predicted preferred preoperative presbyterian prince prior produces pure radiology reconstruct reconstructed reconstruction rectified reduced regular reporting reports resolution room rule saturation scar screens selected separation shortened since site skin slice spiral streamlined studies summary superficial superior surgeons surgery surgical system target temporal thigh tissue tool trajectory tucking umbilical underwent uniform unilateral vascular venous vessel vessels visualization visualized volumes water years