Preoperative mapping of source blood vessels for custom-made flaps in oncoplastic breast surgeries

Background
Breast reconstruction after breast cancer excision is becoming increasingly important owing to changes in patient expectations and demand. There is growing recognition that immediate reconstruction in appropriately selected women can combine an oncological and esthetic procedure in one operation with excellent results. In some oncoplastic techniques or in patients with severe macromastia undergoing reduction, surgeons might not be able to use traditional pedicles because the blood supply of the nipple–areolar complex (NAC) may be altered or destroyed, necessitating the urge to locate an alternative adequate feeding vessel for NAC away from the resected tissues to avoid postoperative vascular compromise. This would improve NAC survival, wound healing, and rapid full recovery, permitting early administration of radiotherapy or chemotherapy if needed.
Aim
This study aimed to characterize NAC blood supply using magnetic resonance angiography (MRA) to locate available alternative and adequate feeding vessels to design a custom-made NAC flap away from the proposed resected area in patients with breast cancer to avoid postoperative vascular compromise.
Patients and methods
This prospective randomized study was performed on 15 patients presented to plastic, burn, and maxillofacial surgery department, Ain Shams University Hospitals, with breast tumors amenable to NAC preservation from January 2018 to June 2022. Bilateral breast MRA was performed using an MRI scanner locating the different adequate pedicles that supply the NAC. Based on MRI results, a custom-made NAC flap was designed and used in oncoplastic reconstruction after tumor excision.
Results
MRI could delineate multiple feeding vessels of variable diameters. Based on these results, different flaps could be used for NAC transposition and breast remodeling. All cases went uneventful regarding NAC vascularity, and six patients showed minimal wound complications that did not delay the administration of postoperative adjuvant tumor therapy.
Conclusion
Preoperative marking of the available feeding vessels of the NAC using MRA played a central role in designing untraditional NAC flaps that can be used in oncoplastic surgery or severe macromastia reduction with minimal complications.