Presurgical Planning

Pre-Operative Blood Vessel Mapping

There is significant variability from one person to another, in the anatomy of the small blood vessels known as “perforators,” and this contributes to the complexity of perforator flap breast reconstruction surgery. Dr. Greenspun is recognized as an expert in the field of preoperative perforator flap blood vessel imaging. He has lectured at meetings around the world about the non-invasive imaging techniques that he helped to develop to improve perforator flap surgical flap outcomes. The ability to establish a “map” of each patient’s blood vessels before surgery dramatically reduces the time it takes to perform these procedures and, importantly, allows surgery to be performed with the highest possible degree of safety and efficacy. Without pre-operative blood vessel imaging, a surgeon will not be able to see a patient’s vessels until surgery is underway.

Together with radiologists at Montefiore Medical Center, Dr. Greenspun has developed specialized techniques that use magnetic resonance imaging (MRI) to reveal—in medical terms, image—the tiny blood vessels of the abdominal wall before DIEP flap or SIEA flap surgery. Working with radiologists at the Weill Medical College-Cornell University in New York City, he helped develop protocols that allow surgeons to use MRI to map the blood vessels used in various flaps including DIEP flaps, SIEA flaps, SGAP flaps, IGAP flaps, LAP flaps and TUG flaps. Unlike CT-scans, which can also be used to image perforator flap blood vessels before surgery, MRI scans do not expose women to radiation and its potentially harmful effects. Dr. Greenspun and other perforator flap surgeons now routinely use these imaging techniques to help identify the very best blood vessels for each patient’s reconstruction.

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