206 posters, 13 topics, 5 sessions, 713 authors, 293 institutions

AAPS 104th Annual Meeting

May 2-5, 2026 | Lihue, HI

D98

Preoperative Perforator Mapping Reduces 90-Day Unplanned Reoperation After DIEP Flap Breast Reconstruction

View Poster Contact Presenter

Poster Presenter

Sahil Sharma

Authors

Sahil Sharma, Sheuli Chowdhury, Martha MacDonald, Patricia Fuentes, Emma Lascar, Alexander Kagen, Alice Yao, Peter Taub, Peter Henderson

Affiliations

Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, Division of Plastic and Maxillofacial Surgery, Icahn School of Medicine at Mount Sinai, Division of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai

Part of Topic

Breast Reconstruction

Preoperative Vascular Mapping Reduces Major Complications After DIEP Flap Breast Reconstruction: A Causal Machine Learning Analysis

Sahil Sharma, BS1, Sheuli Chowdhury, MD1, Martha M. MacDonald BSBA1,Patricia M. Fuentes, BA1 ,Emma Lascar, BS1, Alexander C. Kagen, MD2, Alice S. Yao, MD1, Peter J. Taub, MD MS1, Peter W. Henderson, MD MBA1

1Division of Plastic and Maxillofacial Surgery, 2Division of Diagnostic, Molecular and Interventional Radiology

Icahn School of Medicine at Mount Sinai (New York, NY)

1. BACKGROUND

§Deep inferior epigastric perforator (DIEP) flap breast reconstruction relies on perfusion from perforators of the deep inferior epigastric vessels

§Preoperative vascular mapping with computed tomography angiography (CTA) or magnetic resonance angiography (MRA) is increasingly used to identify perforator location, quantity, and quality

§Evidence on whether vascular mapping reduces unplanned reoperation within 90-days (major complications) is limited

2. OBJECTIVE

To determine whether preoperative vascular mapping (CTA or MRA) reduces major complications following DIEP flap breast reconstruction

3. METHODS

§Single-institution retrospective review of DIEP flap patients (Mar 2017 – Jun 2024)

§Imaging group: preoperative CTA or MRA

§No imaging group: no preoperative vascular imaging

§Primary outcome: any major complication;

§Secondary outcomes: any major donor site complication; any major recipient complications

§Doubly robust causal inference via augmented inverse probability weighting (AIPW) adjusting for demographics, comorbidities, oncologic and operative characteristics to calculate average treatment effect with SuperLearner machine learning ensemble

§Risk differences (RDs) with 95% CIs reported

§Statistical significance (*) set to p < 0.05

4. RESULTS

§Imaging group (n=522) | No Imaging group (n=163)

§Patients who had imaging had 11.5% lower risk of any major complication
(p = 0.002)

§5.5% lower risk of a major donor site complication (p = 0.043)

§9.3% lower riskof a major recipientsite complication (p= 0.007)

5. CONCLUSION

Across the full population of DIEP flap breast reconstruction patients, preoperative vascular mapping reduced major complications at both

donor and recipient sites

6. CLINICAL RELEVANCE

Reconstructive surgeons should strongly consider routine preoperative vascular mappingbefore DIEP flap breast reconstruction to reduce risk of major complications