Preoperative Imaging in DIEP Flap Breast Reconstruction

Preoperative Imagining in DIEP Flap Breast Reconstruction: A Randomized Controlled Trial Evaluating Cost and Patient-Reported Outcomes

The purpose of this study is to determine whether preoperative abdominal imaging using either CT angiogram (CTA), or MR angiogram (MRA) will impact perforator dissection time, cost, and patient outcomes in DIEP flap breast reconstruction.

This study will prospectively compare the clinical, economic and patient outcomes of preoperative imaging using either CTA or MRA with those of no preoperative imaging in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Subjects will randomly undergo either a CTA scan or an MRA scan, or no scan (control) preoperatively. An operative plan based on perforator size and course will be devised by an interventional radiologist and a plastic surgeon. The DIEP flap procedure will be planned for controls. Subjects will not be told if the operative plan is changed intraoperatively. Flap dissection time and changes in operative plan will be recorded intraoperatively and surgeon stress will be evaluated following surgery. Pain and narcotic use will be evaluated preoperatively and on days 1-4 postoperatively. The Breast-Q will be completed preoperatively and at 3 weeks, 3 months and 12 months postoperatively. Groups will be compared in terms of all variables measured.

Time to reach exposure of perforators combined with time for flap elevation will be recorded during the surgical procedure.

Self-administered quality of life and outcomes questionnaire for women that undergo breast reconstruction.

Change of operative plan either prior to surgery as a result of preoperative imaging, or intra-operatively, will be recorded

Completed by the operating surgeon to evaluate workload based on 6 scales: mental demand, physical demand, temporal demand, performance, effort and frustration.

The costs of medical imaging and operating expenses will be calculated and compared between study groups.

Inclusion Criteria: candidate for DIEP flap breast reconstruction speak/read/write English have undergone or will undergo unilateral or bilateral mastectomy Exclusion Criteria: previous abdominal surgery that may preclude a DIEP flap reconstruction active smoker BMI over 35 severe claustrophobia sensitivity to intravenous CT contrast medium (Visipaque 320) or MR contrast medium (Gadovist 1.0) urgency of surgery that precludes study enrollment