Clinical utility of a 3D-printed guide and vascular model for deep and superficial inferior epigastric vessels in breast reconstruction.

Background

Although 3D-printing has been applied across multiple surgical fields, comparative evidence for computed tomography angiography (CTA)-derived patient-specific guides in abdominal-based breast reconstruction remains limited. We evaluated a CTA-derived 3D-printed surgical guide and vascular model incorporating both deep and superficial inferior epigastric vessels.

Methods

We retrospectively reviewed abdominal-based breast reconstructions from June 2024 to September 2025 by comparing patient-specific 3D-printed and CTA-only planning data. Outcomes of interest included flap harvest time, postoperative pain, complications, discrepancy between guide-based and manual CTA-derived deep inferior epigastric perforator (DIEP) surface markings, and discrepancy between guide-based superficial inferior epigastric vein (SIEV) markings and intraoperatively identified SIEV locations.

Results

Among the 130 patients (CTA-only, n=75; 3D-printed, n=55), the 3D-printed group had shorter overall flap harvest time (184.0 vs. 158.0 min; p=0.039) and shorter harvest time for unilateral, unipedicled DIEP flaps (182.5 vs. 158.0 min; p=0.025). Fasciotomy length in unipedicled DIEP flaps was shorter and visual analog scale pain scores from postoperative days 3-5 were lower in the 3D-printed group (all p<0.05), whereas opioid consumption and complications were comparable between the groups. The median radial discrepancy between the two CTA-derived DIEP surface-marking methods was 5.05 mm and median lateral discrepancy between the guide-based marking and intraoperatively identified SIEV location was 1.00 mm.

Conclusions

The 3D-printed workflow was associated with shorter flap harvest time and shorter fasciotomy length in unipedicled DIEP flaps. These findings indicate a potential improvement in operative efficiency and further studies are needed to determine its clinical significance.