1. Torevise the anatomy of the deep inferior epigastric artery (DIEA) and understand how its perforators are used in free flap surgery for breast reconstruction. 2. How to protocol and reconstruct the CT angiograms to allow optimal visualisation of the DIEA and its perforators to aid in preoperative planning. 3. To understand what the plastic surgeon needs to know from the scan to aid in surgical planning and important items to include in every report.

The deep inferior epigastric artery perforator (DIEP) free flap is a tool in the armamentarium of the plastic surgeon which is most often employed for breast reconstruction, usually after mastectomy for breast cancer or prophylactic surgery. Skin and subcutaneous tissue from the abdomen perfused by at least one perforator arising from the deep inferior epigastric artery (DIEA) are harvested and used to create the new breast which is usually anastomosedwith the internal mammary vessels in the chest. They are colloquially termed "the Rolls Royce" of...

DIEA & its Perforators The DIEA arises medially from the external iliac artery and travels cephalad between the posterior rectus sheath and the rectus abdomins muscle giving off perforators anteriorly. These perforators travel anteriorly through the rectus muscle (intramuscular course), run posterior to the anterior rectus sheath (subfascial course) which it eventually pierces to supply the subcutaneous tissue and skin. Three branching patterns of the DIEA have been described and are easy to remember [2]: Type 1: a single DIEA Type 2: the DIEA branches...

Preoperative CT angiogram for planning DIEA perforator flaps for breast reconstruction is becoming more utilised and will likely soon be the standard of care. Knowledge of the anatomy, its variations as well as understanding what the plastic surgeon needs to know from the scan are important if we are to add value to these reports.

G. Rahmani; Galway/IE - nothing to disclose R. McLoughlin; Galway/IE - nothing to disclose

[1] Wade RG, Watford J, Wormald JCR, Bramhall RJ, Figus A. Perforator mapping reduces the operative time of DIEP flap breast reconstruction: A systematic review and meta-analysis of preoperative ultrasound, computed tomography and magnetic resonance angiography. J Plas Reconstr Surg 2018;71:468-477 [2] Moon HK, Taylor G. The vascular anatomy of the rectus abdominis musculocutaneous flaps based on the deep inferior epigastric system. Plast Reconstr Surg 1988;82:815e32