Comparative Study between Computed Tomography Angiography and Doppler Ultrasound in Reduction Mammoplasty

Background: Breast hypertrophy is a challenging condition
as it is associated with increased body burden and chest oppression.
The most devastating complication of breast reduction
which is post-operative necrosis of the nipple-areola complex
(NAC).
Objective: This prospective case series study was to investigate
the vascular supply to the NAC and to compare between
Doppler ultrasound and computed tomography angiography for
surgical planning of breast pedicle in reduction mammoplasty.
Patients and Methods: The study was conducted on a total
of 17 cases scheduled for reduction mammaplasty in The Plastic
Surgery Department at Mansoura University. Preoperative
CT angiography, Doppler ultrasound, and intraoperative Doppler
ultrasound were used to conduct our study. Radiologists
and plastic surgeons work together to conduct a presurgical
plan according to the 3D scan and accompanying measurement
parameters. Consequent follow-ups happened immediately after

surgery, for up to 6 months, assessing necrosis rates and adverse
events of the NAC.
Results: Based on CTA, on the right side, we could detect the most
dominant Inferior perforators in 58.8%, Superiomedial perforator
in 41.2%, Superior perforator in 11.8%. In left side, Inferior
perforators in 41.2%, Superiomedial perforator in 35.3%, Superior
perforator in 17.6%.
Based on Doppler ultrasound, in right breast we could detect
most audible inferior equal to superiomedial perforators in
41.2%.
It does not necessitate that the most audible perforator by
Doppler or the most dominant one by CTA to be selected to
survive NAC.
Conclusions: Doppler ultrasound is a valuable method to
help in pedicle selection in reduction mammoplasty, which has
matching results with CT angiography in 75% of the examined
right breasts and 87.5% in the left ones.