Autologous breast reconstruction by free microsurgical transfer necessitates adequate recipient vessels. The internal mammary and thoracodorsal vessels are the most commonly used recipient vessels. Previous surgery and radiation therapy may render these vessels unsuitable for microvascular anastomosis. This study evaluated the usefulness of CT angiography in guiding preoperative planning for complicated autologous breast reconstruction.

Five patients with a mean age of 42 years underwent breast reconstruction by free-tissue transfer after having previous oncologic breast surgery with axillary lymph node dissection. The thoracodorsal vessels were evaluated and felt to be suitable as recipient vessels in two patients. Free TRAM reconstruction using the thoracodorsal vessels as recipients were performed in these two patients. In two of the remaining patients , the internal mammary vessels were deemed adequate. Surgical exploration confirmed these findings and an uncomplicated free TRAM was performed to the internal mammary vessels. One patient had a poorly visualized internal mammary vein. Surgical exploration confirmed the vein to be small and friable. This patient underwent a delay procedure followed by a contralateral pedicled TRAM flap reconstruction 2 weeks later.

CT angiography is a relatively easy and safe imaging modality which can help determine the adequacy of recipient vessels for free tissue transfer. The patency and size of thoracodorsal and internal mammary vessels can be evaluated by a single study. Furthermore, the presence of perivascular scarring surrounding the axillary vessels can seen. Target recipient vessels for microsurgical transfer can be determined preoperatively, and operative dissection of nonusable axillary vessels can be avoided. These findings indicate that, in the patient who is a candidate for delayed, autologous breast reconstruction, CT angiography can provide useful information to guide preoperative planning.