 Introduction/Background Breast cancer is the most common malignancy in women in the United States, with surgical options including lumpectomy and mastectomy. Breast reconstruction options following mastectomy range from saline or silicone implants to autologous breast reconstruction. The latter procedure uses skin, fat, blood vessels, and/or muscle from the upper back, abdomen, buttocks, or hips. Transverse rectus abdominis muscle flap procedure is a traditional method of breast reconstruction that harvests underlying muscle. This can result in increased donor site morbidity. The deep inferior epigastric perforator (DIEP) flap is a muscle-sparing perforator free flap breast reconstruction technique, which uses the deep inferior epigastric artery (DIEA) perforators to create a vascular pedicle [1]. Compared with transversus rectus abdominus muscle flaps, DIEP flaps result in less fat necrosis and loss of function at the donor site. The DIEP tissue harvesting procedure involves dissecting the anterior abdominal wall subcutaneous tissues to locate and visually identify the most suitable vessel to serve as the vascular pedicle. Although the DIEA is reliably identified because of its consistent take off from the external iliac artery, the anatomy of the perforators used in DIEP flap is variable. Lack of preoperative imaging can lead to increased operative times given the time-consuming nature of identifying the variable vascular anatomy. The efficiency of the vascular pedicle selection process can be significantly improved with preoperative imaging [2]. Multiple perforators are identified by imaging, which are typically ranked based on size, location, and intramuscular course. The ideal perforator is the largest caliber [1,3] and is medially located within the flap with an extended vascular territory beyond the midline to provide optimal perfusion.
Imaging of Deep Inferior Epigastric Arteries for Surgical Planning Breast Reconstruction Surgery .  Introduction/Background Breast cancer is the most common malignancy in women in the United States, with surgical options including lumpectomy and mastectomy. Breast reconstruction options following mastectomy range from saline or silicone implants to autologous breast reconstruction. The latter procedure uses skin, fat, blood vessels, and/or muscle from the upper back, abdomen, buttocks, or hips. Transverse rectus abdominis muscle flap procedure is a traditional method of breast reconstruction that harvests underlying muscle. This can result in increased donor site morbidity. The deep inferior epigastric perforator (DIEP) flap is a muscle-sparing perforator free flap breast reconstruction technique, which uses the deep inferior epigastric artery (DIEA) perforators to create a vascular pedicle [1]. Compared with transversus rectus abdominus muscle flaps, DIEP flaps result in less fat necrosis and loss of function at the donor site. The DIEP tissue harvesting procedure involves dissecting the anterior abdominal wall subcutaneous tissues to locate and visually identify the most suitable vessel to serve as the vascular pedicle. Although the DIEA is reliably identified because of its consistent take off from the external iliac artery, the anatomy of the perforators used in DIEP flap is variable. Lack of preoperative imaging can lead to increased operative times given the time-consuming nature of identifying the variable vascular anatomy. The efficiency of the vascular pedicle selection process can be significantly improved with preoperative imaging [2]. Multiple perforators are identified by imaging, which are typically ranked based on size, location, and intramuscular course. The ideal perforator is the largest caliber [1,3] and is medially located within the flap with an extended vascular territory beyond the midline to provide optimal perfusion.