An innovative method of planning and displaying flap volume delineations additional to perforator mapping to achieve symmetric breast volumes in DIEP flap breast reconstructions

S Hummelink, AC Verhulst, TJJ Maal, YL Hoogeveen, LJ Schultze Kool, DJO Ulrich
Radboudumc, Nijmegen, The Netherlands


Determining the ideal volume of the harvested flap in order to achieve symmetry in deep inferior epigastric artery perforator (DIEP) flap breast reconstructions is complex and relies generally on surgeon skill and insight.

As various preoperative imaging techniques are available nowadays, we aimed to preoperatively plan the correct flap size and incorporate the flap size into a 3D patient-specific perforator map. In this proof-of-concept study, we studied the feasibility of displaying the flap size along with a 3D patient-specific perforator map onto the patient's abdomen using a projection method.


In ten patients (n=14 flaps), the preoperative breast volume using 3D stereophotogrammetry was derived. On 3D rendered Computed Tomography Angiography (CTA) reconstructions flap size on the donor site was delineated to match the measured breast volume. A patient-specific perforator map was created comprising perforator locations, blood vessel trajectory based on CTA and elaborated with the flap size to be harvested. The resulting 3D patient-specific perforator map was projected and traced with a marker pen onto the patient's skin. After projection, the flap size was approved by the surgeon and harvested. Intraoperative flap measurements were collected to validate the determined flap delineation volume.


The measured breast volume using 3D stereophotogrammetry was 588±117 cc; on CTA images 550±101 cc flap volumes were planned. Four flaps were excluded as flap delineation changed (n=2) and/or an ALNT flap was added to the harvested flap (n=3). The 10 remaining harvested flaps weighed 542±107 g resulting in a planned versus harvested flap difference of 15±40 g (ratio: 1.03±0.08).


This proof-of-concept study demonstrates that combining various 3D imaging techniques may provide aid in preoperative flap volume quantification for achieving symmetric breast volumes in DIEP flap breast reconstructions.