Objective. To determine an optimal method of the surgery planning and the perforator vessel selection in delayed deep inferior epigastric artery perforator (DIEAP) flap breast reconstruction (BR).

Material and methods. A total of 119 female patients with a mean age of 46.3 (range 27—59) years and a mean body mass index of 28.57 (range 21.7—36.9) kg/m2 who underwent delayed unilateral DIEAP flap BR were enrolled in this study. Patients were divided into two groups: the first included 72 women who underwent preoperative planning using non-contrast magnetic resonance angiography (MRA), the control group included 47 patients who underwent computed tomography angiography (CTA). We also analyzed the correlation between the row of the perforators and perfusion-related complications development in the flap. Statistical analysis was performed using the program StatTech v. 4.7.2 (StatTech LLC, Russia).

Results. The overall operation time averaged 337.0 min in MRA group and 348.82 min in CTA group, particularly the time of the pedicle cut was 36.5 min in MRA group versus 45.5 min in CTA group (p<0.001). We found a statistically significant correlation between flap harvesting on medial row perforators and the risk of marginal flap necrosis and fat necrosis development.

Conclusion. Contrast-free MRA combines the advantages such as no ionizing radiation exposure, requires no potentially harmful contrast agent, and at the same time is high efficiency in relation to navigation on the pedicle cut stage.

Keywords. breast reconstruction, DIEAP flap, preoperative planning, perforator flaps, computed tomography angiography (CTA), magnetic resonance angiography (MRA)