A Clinical Anatomic Study of Internal Mammary Perforators as Recipient Vessels for Breast Reconstruction

Baek, In Soo; You, Jae Pil; Rhee, Sung Mi; Son, Gil Su; Kim, Deok Woo; Dhong, Eun Sang; Park, Seung Ha; Yoon, Eul Sik

doi:10.5999/aps.2013.40.6.761

Cited by 15 publications

(17 citation statements)

References 13 publications

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“…However, in the case of turbocharging, the variation of the diametric difference between flap pedicles was very diverse and technically difficult to anastomose, so the supercharging anastomosis was preferred by the ease to manipulate. The TD vessels are commonly used recipients for immediate breast reconstructions because they are obtainable after axillary dissection during mastectomy [18]. Although IM vessels have been applied more frequently in recent years, the results of a meta-analysis show that both the IM and TD vessels are safe as recipients without no significant difference in rates of flap failure or other complications [24].…”

Section: Discussionmentioning

confidence: 99%

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Diametric Comparison between the Thoracodorsal Vessel and Deep Inferior Epigastric Vessel in Breast Reconstruction

Kim

Moon

et al. 2020

BioMed Research International

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Background. In microvascular anastomosis, size discrepancy is common and can increase thrombotic complications. If size differences can be predicted, then vessels of the appropriate size can be selected. This study documented the difference in diameter between the thoracodorsal (TD) vessel and deep inferior epigastric perforator (DIEP) pedicle in each patient who underwent breast reconstruction using free tissue transfer. Patients and Methods. This retrospective study included 32 anastomoses (27 breasts including five cases of supercharged anastomosis) of breast reconstruction with the free DIEP flap and TD recipient between August 2018 and June 2019. In the microscopic view, the caliber of the TD vessel, the largest branch to the serratus anterior muscle, the descending branch, the largest and the second largest branches to the latissimus dorsi muscle, and the DIEP pedicle were measured. Results. The diameter of the deep inferior epigastric artery was similar to that of the descending branch, and their anastomosing rate was 56.3%. The diameter of the deep inferior epigastric vein was similar to the branch to the serratus anterior muscle and the descending branch, and their anastomosing rates were 29.3% and 29.3%, respectively. All flaps were survived; however, in one case, a reoperation was needed to remove the hematoma, in which case fat necrosis occurred as the only complication. Conclusion. TD branches of similar size to the DIEP pedicle were prioritized in anastomosis. The descending branch and the branch to the serratus anterior muscle are expected to be good candidates as recipients in breast reconstruction with DIEP free flap. Moreover, supercharged anastomosis of DIEP pedicles can be achieved within TD branches.

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Section: Discussionmentioning

confidence: 99%

“…The thoracodorsal (TD) vessels are reliable and obtainable recipients in microsurgical breast reconstruction and are preserved during mastectomy and dissection of axillary lymph nodes [17,18]. Even the advantage of using TD vessel is that it is easy and quick to prepare as the recipient vessel [19].…”

Section: Introductionmentioning

confidence: 99%

Diametric Comparison between the Thoracodorsal Vessel and Deep Inferior Epigastric Vessel in Breast Reconstruction

Kim

Moon

et al. 2020

BioMed Research International

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“…Previous methods of recipient vessel preparation have relied on the partial excision of costal cartilage (Sacks & Chang, ; Saint‐Cyr, Youssef, et al, ). However, these rib resection may result in chest‐wall contour defects, pneumothorax, and postoperative pain (Baek & Yoon, ). IMA perforators, when preserved, are readily available, obviating the need for further surgical dissection and morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…IMA perforators, when preserved, are readily available, obviating the need for further surgical dissection and morbidity. Likewise, their more superficial entrenchment means less interference from cardiorespiratory chest‐wall motion and affords the use of shorter flap pedicles (Baek & Yoon, ; Follmar et al, ; Hamdi et al, ; Saint‐Cyr, Chang, et al, ; Vollbach et al, ).…”

Section: Discussionmentioning

confidence: 99%

Expanding the use of internal mammary artery perforators as a recipient vessel in free tissue transfer: An anatomical analysis by computed tomography angiography in breast cancer patients

et al. 2019

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Background: The internal mammary artery (IMA) perforator has assumed recent prominence as recipient vessels in free autologous breast reconstruction. However, anatomical understanding is unclear, due to limited cadaver and clinical studies. We evaluated the usability of these vessels by evaluating perforator size, dominance, laterality, interspace location, and relationship with breast volume.Methods: A retrospective review assessed 197 female patients with breast cancer who had undergone computed tomography angiography (CTA) of the chest wall. The average age and body mass index (BMI) of patients was 49.0 ± 6.5 years and 24.2 ± 5 .8 kg/m 2 , respectively.The average volume of breasts was 437 ± 190 mL. Our analysis focused on the anatomy of IMA perforator and its relationship to volume and BMI.Results: A total of 377 hemi-chest evaluations were performed. Most patients (95.5%) had sizeable perforating artery identified on CTA. Among all sizeable perforators identified, the mean diameter of the most dominant arterial perforator was 1.8 ± 0 .8 mm. The right hemi-chest had significantly larger perforators than the left (1.9 ± 0 .9 mm vs. 1.7 ± 0 .7 mm, p = 0.002). The first intercostal space (ICS) had a slightly greater of perforators than second ICS (34.6% vs. 29.8%, p = 0.172). However, second ICS had a greater number of most dominant perforators compared to first ICS (38.9% vs. 34.7%, p = 0.357). Perforators from first ICS emerge medial to the sternal edge and breast footprint. When dividing groups with 0-1 versus 2-3 reliable perforators, breast volume was significantly higher in the later (422.0 mL vs. 461.2 mL, p = 0.019). Conclusion:These results are expected to encourage microsurgeons to use the IMA perforator by providing a clear anatomical roadmap.

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“…Park et al () used four free TRAM flaps and one supercharging pedicled TRAM flap in which the inferior epigastric artery and vein were anastomosed to the internal thoracic artery perforators of the third intercostal space, and they reported the diameter of the recipient vessels as 1.2–1.5 mm for the artery and 1.0–2.2 mm for the vein. Baek et al () reported a clinical anatomical study of the internal thoracic artery perforators of 12 patients in which the largest arterial perforator averaged 1.5 mm, the largest venous perforator averaged 2.2 mm, and the second ICS had the largest number of perforators.…”

Section: Discussionmentioning

confidence: 99%

Distribution of internal thoracic artery perforators: A clincal anatomy study

Kim

Lee

et al. 2018

Clinical Anatomy

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There are various modifications of the transverse rectus abdominis musculocutaneous flap and deep inferior epigastric perforator flap to reduce the morbidity of the donor site or to augment the vascularity of the flap. For microanastomosis of multiple pedicles, multiple recipient vessels or an intervening vein graft should be provided. In addition, alternative perforator-based flaps used in breast reconstruction have small caliber pedicles. Therefore, small recipient vessels such as internal thoracic artery perforators are more suitable for appropriate microanastomosis. Therefore, it is important to acquaint the distribution and anatomical characteristics of internal thoracic artery perforators. We researched the perforators running in the intercostal spaces under the pectoralis major muscle to provide an overview of the anatomical distribution and characteristics of the perforators in patients who underwent immediate subpectoral implant-based breast reconstructions. In our study, the major perforators (diameter > 1.5 mm) were easily found 2-7 cm medially between the third and fourth intercostal space and were sparse in the lateral area from the midline of the breast (usually 8-9 cm lateral to the midsternal line) and above the third rib. In each side of the breast, the average number of perforators greater than 1.5 mm was 1.6, and the average number of perforators between 1 mm and 1.5 mm in diameter was 3.2.Our results provide information about perforators in the anterior chest wall related to the breast area. Clin. Anat. 32:471-475, 2019.

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A Clinical Anatomic Study of Internal Mammary Perforators as Recipient Vessels for Breast Reconstruction

Cited by 15 publications

References 13 publications

Diametric Comparison between the Thoracodorsal Vessel and Deep Inferior Epigastric Vessel in Breast Reconstruction

Diametric Comparison between the Thoracodorsal Vessel and Deep Inferior Epigastric Vessel in Breast Reconstruction

Expanding the use of internal mammary artery perforators as a recipient vessel in free tissue transfer: An anatomical analysis by computed tomography angiography in breast cancer patients

Distribution of internal thoracic artery perforators: A clincal anatomy study

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