title: Incidence of 'Incidentalomas' in over 100 consecutive CT angiograms for preoperative DIEP flap planning.
abstract: The gold standard in breast reconstruction is the deep inferior epigastric perforator (DIEP) flaps, although muscle-sparing tranverse rectus abdominis myocutaneous (TRAM) flaps are still being performed due to variations in the abdominal vasculature and to reduce flap complications. Recently, there has been a rise in interest in preoperative imaging, in particular, by means of computer tomography angiogram (CTA). CTA has been shown to delineate the vascular anatomy, improve preoperative decision making and possibly reduce operating time and constitutes a routine preoperative investigation in our unit. Of the 104 consecutive patients who had undergone CTA prior to breast reconstruction, we have found a 13% incidence of unexpected findings or 'incidentalomas' in otherwise asymptomatic women. None were malignant, but changes to the initial operative plan included deferring immediate breast reconstruction, further surgery and further investigations for these incidentalomas. We recommend that all women are counselled of the possibilities of incidentalomas prior to CTA. Furthermore, clinicians need to be receptive to the possibility of a delayed or alternative reconstruction, and closely liaise with other specialties to avoid damage to the deep inferior epigastric vasculature.
authors.affiliation: Department of Plastic Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK. marlene_see@yahoo.com
authors.forename: Marlene S
authors.initials: MS
authors.lastname: See
authors.forename: Marc D
authors.initials: MD
authors.lastname: Pacifico
authors.forename: Oliver J H
authors.initials: OJ
authors.lastname: Harley
authors.forename: Ian
authors.initials: I
authors.lastname: Francis
authors.forename: Roger W
authors.initials: RW
authors.lastname: Smith
authors.forename: Martin E
authors.initials: ME
authors.lastname: Jones
mesh_terms: D000005:Abdomen / Q000098:blood supply; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011300:Preoperative Care; D013524:Surgical Flaps / Q000098:blood supply*; D014057:Tomography, X-Ray Computed