Preoperative CT angiography to facilitate pedicle selection for high-risk breast reduction patients

This study aimed to investigate the dominant vascular supply to the nipple areolar complex (NAC) using CTA and whether the preoperative CTA could change surgical planning and reduce the incidence of nipple necrosis after breast reductions for patients considered to be at a high risk of nipple loss.Methods: All female CT thoraces performed at a single centre between January and May 2013 were reviewed by a single cardiothoracic radiologist to find arterial sources, which intercostal space that was perforated, glandular/subcutaneous course and vessel entry point into the NAC of each breast. Preoperative planning CTA’s performed for the 28 cases of high-risk breast reductions of the 392 breast reductions between 2008 and 2014.Results: Analysis was performed on CTAs of 69 patient cases, involving 132 breasts. The dominant blood supply was the internal mammary artery (IMA) in 96 breasts, with long thoracic artery (LTA) in 21 breasts. A dominant vascular supply was identified in all cases. In 27 of the 28 cases, preoperative planning was undertaken as guided by the CTA. Of the 28 cases, there was one case of unilateral infection, one hematoma, and a single case of partial thickness areolar necrosis. No free nipple grafts were required.Conclusion: Preoperative CTA for large-volume breast reduction may be a useful surgical planning tool for high-risk patients. With CTA, pedicle design can be tailored to the specific patient’s blood supply in order to reduce the incidence of necrosis and avoid the need for free nipple grafts.