Contralateral Autologous Augmentation in DIEP Flap Reconstruction: Employing Computed Tomography Angiography and Volumetric Analysis for Preoperative Planning

Autologous reconstruction accounts for approximately 20% of all breast reconstruction procedures. In cases of unilateral reconstruction, contralateral breast augmentation using autologous tissue can be performed to improve symmetry, and it is a viable option for patients interested in having more volume relative to their current size without the use of implants. Computed tomography scans have been used for preoperative planning in autologous reconstruction to evaluate available perforators. In this article, the authors report their experience using computed tomography angiography for preoperative volumetric assessment for autologous contralateral breast augmentation in the setting of unilateral autologous breast reconstruction. Twelve patients underwent autologous augmentation during the study period. The average reconstruction flap weight was 561.2 ± 253.6 g, and the average augmentation flap weight was 218.0 ± 133.7 g. No patients experienced flap loss. The authors demonstrate that the predicted volumes for the augmented and reconstructed breasts were comparable to the actual respective flap volumes. In addition, postoperative patient-reported outcome measures demonstrated high levels of satisfaction across multiple BREAST-Q subscales. This study demonstrates the utility of using computed tomography angiography to estimate reconstructive volumes to help preoperative planning and achieve predictable postoperative breast volumes. It also supports that contralateral autologous augmentation is a good option for patients who would like to avoid implants and are interested in a small to moderate increase in size.