Methods

A retrospective, descriptive observational study was carried out interpreting 194 tomosynthesis studies for vascular evaluation carried out at Centro Médico Docente la Trinidad in 2022. First, the findings in tomosynthesis in the MLO and CC projections were interpreted, taking into account the surgical history and the density of the breast tissue according to the ACR, in search of the dominant vascular pedicle, describing the vascular pattern for each breast quadrant and characterizing the vessels according to their diameter to predict the quality of the irrigation of the nipple areola complex.

Background:

A narrative review talks about tomosynthesis as the "new era of mammography" in 2014 as a new tool and a safe method, with radiation doses within the allowed ranges, which is demonstrating important changes in diagnosis (1) (6).

The study carried out by Rincon et al in Venezuela, in 2017 sought to determine if 3D mammography/tomosynthesis is the method of choice to visualize the vascular pattern of the nipple-areola complex (NAC) in secondary breast surgery: augmentation, reduction and mastopexy mammoplasty with or without implants, to avoid complications from the point of view of its irrigation. As a result, no case of NAC necrosis occurred (7).

Capecchi et al. in 2018 decided to evaluate the usefulness of using tomosynthesis as part of the preoperative protocol for mammoplasties, through a retrospective, descriptive study. The sample consisted of 67 patients who underwent tomosynthesis and breast ultrasound, resulting in only one case of nipple-areola complex necrosis and thus concluding that the use of tomosynthesis alone, helps to plan the surgical technique and reduce postoperative complications (8).

In a randomized controlled trial conducted in 2019, freestyle perforator flaps were performed on 105 patients using the Color Doppler ultrasound method for detection of perforating branches and thus avoid necrosis of the nipple areola complex postoperative of reducing mammoplasty surgeries, because this is one of the most devastating scenarios for patients undergoing this type of surgery. In all 105 cases, there was not one case of necrosis of the NAC, but seven cases suffered from ischemia that healed under conservative treatment (9) (10).