A new study conducted at UT Southwestern suggests that — at least in unilateral breast reconstruction surgery — preparation truly is key. The study evaluates the success of UT Southwestern’s pre-procedure approach, which involves mapping blood vessel connections and determining pedicle design using computed tomographic angiography (CTA).
CTA — an imaging technique that many surgeons use to assess the quality of blood vessels and determine which they will use during surgery — involves intravenously injecting contrast material into the blood vessels, then performing a CT scan to examine the area of the body where the flap will exist. In breast reconstruction surgeries, this area is often the abdomen.
Typically, surgeons determine the design of the flap during surgery. At UT Southwestern, however, surgeons use CTA imaging not only to map which blood vessels to use during surgery, but to plan the design of the pedicle flap preoperatively. “The CTA scan allows us to visuospatially create a model of the breast in advance so we can be faster in the operating room. The surgeons still visually confirm the scan results during surgery, assuring a high degree of reliability,” associate professor of plastic surgery at UT Southwestern Medical Center and director of the breast-reconstruction program at UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center, Dr. Sumeet S. Teotia, said in a release.
UT Southwestern surgeons also use CTA imaging to facilitate a pre-op discussion with patients. “Reviewing the scans helps the patient see what we may encounter in surgery and gives them confidence going into the procedure,” Teotia stated. “Potentially, we can reduce and even avoid long-term complications.”
Teotia refers to complications such as fat necrosis — a partial tissue death — which can cause lumpiness or localized pain. This is an especially relevant concern in unilateral breast reconstruction patients with a lower amount of abdominal tissue, large abdominal scarring, and a large and/or sagging existing breast. In these cases, mapping out blood vessels connections, the order in which the connections occur, and how to approach cutting the abdominal flap can often prove the most difficult portion of the entire surgical procedure. UT Southwestern’s pre-procedural algorithm addresses each of these planning components and discusses proposed approaches with the patient.
Recent research investigated the effectiveness of UT Southwestern’s pre-op planning methods, analyzing data from 75 unilateral breast reconstruction surgeries of a similar type: those in which surgeons used conjoined, bipedicled hemi-abdominal flaps. In each of the selected surgeries, surgeons used CTA imaging to determine pedicle design and evaluate blood vessel location and quality. Results suggest that UT Southwestern’s approach to preoperative planning is crucial to microsurgical success in this particular type of unilateral breast reconstruction.
“Our algorithm allows us to be anatomically strategic in choosing the best blood supply for that particular tissue; it is important to have optimal blood supply for the best results, which ultimately translates into an improved outcome and breast shape,” Teotia says.