Previous history of chest, back, or abdominal surgery/trauma: Potential compromise of specific flaps

• 
  

  History of coronary artery bypass grafting: Possible absence of internal mammary arteries (IMAs), which can affect flap viability

Pulmonary disease (chronic obstructive pulmonary disease [COPD], asthma): Increased risk of respiratory compromise in the absence of chest wall skeletal reconstruction

Other comorbidities

Tobacco use

Nutritional status

Etiology of chest wall wound/deformity

• 
  

  Traumatic, oncologic, infectious, radiation, congenital, or postsurgical

  
  
• 
  

  If oncologic, benign versus malignant: History of (or plan for) radiation therapy, extent of surgical resection planned, and surgical approach (spare locoregional flaps, if possible)

Define defect/mass: Location, depth, and fixed/mobile

Perform lymph node examination

Assess muscle involvement in the chest: Is the pectoralis major involved?

Assess abdomen for hernias and diastasis recti

Evaluate back musculature and soft tissue laxity

Assess for chest wall, back, or abdominal scars

Computed tomography (CT) to evaluate extent of mass/wound/deformity and any involved or absent structures

Angiogram (or magnetic resonance [MR]/CT angiography) if uncertain about vascular anatomy

Pulmonary function tests (PFTs) may be indicated: Help determine need for reconstruction in small defects