This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question. 
Question:Hello, I was wondering if you do a 3T MRI of both the abdomen and the chest before a DIEP flap? I would rather not have more radiation, because I had mantle radiation when I had Hodgkin's 20 years ago and developed breast cancer as a result. Also have you heard of an APEX flap? Thank you for your time.Answer: Thanks for your great question! We perform preoperative MR Angiograms with an open 3T MRI protocol on all possible patients we have who are undergoing breast reconstruction with a DIEP procedure. We do the same for any of the multiple muscle sparing natural tissue reconstruction procedures we regularly perform. We do not perform MR angiogram of the chest. That would not provide us with any useful preoperative planning information. There are quite a few people who cannot have a MRI. People who have metal knee replacements or breast expanders with metal parts are examples of reasons some of our patients cannot have an MRI. In our practice we have found CT angiograms are not as useful and avoid them if we can because of the increased radiation. As you may be aware, your history of previous mantle radiation may also increase your chances for problems with implant breast reconstruction. I agree that a DIEP may be a very good option for you. I hope I answered your question. If you would like more information please let me know.
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