Do you need a CT angiogram before DIEP flap breast reconstruction?

If you've had several previous abdominal surgeries and are considering DIEP flap breast reconstruction, a CT angiogram may be recommended by your plastic surgeon.

A CT angiogram (CTA) is a special type of CT scan that examines the blood vessels in the abdomen to determine if they are intact and able to be used for DIEP flap reconstruction. It can also provide a "road map" for the surgeon and help locate the largest blood vessels ("perforators").

Sometimes the vessels needed for the DIEP flap may have been damaged by previous abdominal surgery. Although the majority of previous abdominal surgeries are not a contraindication for DIEP flap reconstruction (except a tummy tuck), there is a small chance that the blood vessels may be damaged in patients that have had multiple previous abdominal surgeries or certain procedures.

While some surgeons obtain CT angiograms on their patients routinely before DIEP flap surgery, in our opinion not all patients need the study. A very good example is patients who have never had abdominal surgery. Much depends on surgeon preference and experience.

It is also important to realize that the test exposes patients to radiation; in many cases, patients have already had more than their fair share of radiation as part of their breast cancer treatment! At PRMA, we usually only recommend a pre-operative CTA in patients that have had multiple previous abdominal surgeries and there is a question about the vascular anatomy.

There is no doubt, despite the radiation exposure, a CTA can be an excellent planning tool when needed. Be sure to discuss any concerns you have regarding previous abdominal surgeries and the need for a CT angiogram with your plastic surgeon.

I hope this info helps!

Dr C

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Dr Chrysopoulo is a breast reconstruction surgeon in San Antonio, TX, specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer on Facebook.

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Who is NOT a DIEP flap candidate?

With more women becoming aware of DIEP flap breast reconstruction as an option, the question of who is and who isn't a good DIEP flap candidate is coming up more often.

As a general rule, women that have had extensive abdominal surgery like a previous TRAM flap, tummy tuck or a complex hernia repair cannot have a DIEP or SIEA flap breast reconstruction. This is because the lower tummy tissue that is needed has usually been removed or moved around, and the necessary blood supply has been disrupted.

Having said that, most of the time previous abdominal surgery isn't an issue in experienced hands.

Many women these days have had at least one previous c-section or another gynecologic procedure like a hysterectomy. It is possible for these procedures to cause damage to the blood vessels needed for DIEP flap surgery but fortunately this is unusual. A previous c-section, hysterectomy, or tubal ligation is not a contra-indication to having a DIEP or SIEA flap. Previous liposuction is not usually a problem either unless this was extensive.

If your surgeon is worried about potential damage from previous surgery then certain tests can be performed to evaluate your anatomy more closely. This can include a simple doppler ultrasound exam in the office or a more involved test like a CT angiogram. Unfortunately, the CT scan does involve radiation.

While previous abdominal surgeries may not prevent you having DIEP flap reconstruction, women that have had multiple previous abdominal procedures are at increased risk of abdominal complications like bulging and hernia after DIEP flap surgery when compared to women that have never had prior abdominal surgery, even though the abdominal muscles are preserved. This is because the fascia (the strong layer of tissue over the muscles) has already been weakened by the previous surgeries.

Some medical issues can make any form of microsurgical breast reconstruction (like the DIEP flap) more difficult and they can also increase the risk of complications like flap loss. These include disorders that make the blood clot more easily (eg Factor V Leiden).

I hope this info helps.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, Texas specializing in state-of-the-art reconstructive breast surgery. He and his partners at PRMA are In-Network for most major US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients on Facebook.

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