Internal mammary perforator vessels as recipient site for microsurgical breast reconstruction: A comparative histomorphometric analysis and incidence of degenerative vascular changes

Munhoz, Alexandre Mendonça; Ishida, Luís Henrique; Montag, Eduardo; Saito, Fábio Lopes; Mendes, Marcio Henrique; Alves, Helio; Gemperli, Rolf

doi:10.1002/micr.22203

Cited by 9 publications

(6 citation statements)

References 45 publications

(161 reference statements)

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“…However, some studies have reported perforators arising from the first or fourth intercostal spaces in a few cases. 3,5,7 Although there is considerable variation in the use of IMAPs, clinical evidence supports a growing trend in the last decade, ranging from 9% in early studies to 83% in recent years. 2,4,6,8,17,18 The NOS uses a star system to assess the quality of a study, based on selection and outcomes; the quality of the study is rated as low (0-3 stars), medium (4-6 stars), or high (7-9 stars).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…23,24 Although a significant drawback of the size of the IMAPs on the left side, which is somewhat smaller than the contralateral right side and donor pedicle, adequate anastomoses can be performed between IMAPs and deep inferior epigastric artery branches or perforators, the latter ones with a more suitable size match. 2,5,16,18 (3) IMAPs provide a safe anatomical dissection, low complication rate, and satisfactory aesthetic outcome. Up to 75% of these IMAP vessels are usually identified in the superficial subcutaneous plane, and nearly 25% run through the intramuscular or submuscular plane.…”

Section: Fernandez-diaz Et Al • Outcomes Of Imaps Breast Reconstructionmentioning

confidence: 99%

“…The most limiting factor for this choice is caliber size, which ranges from 0.85 to 1.9 mm, located in the second and third intercostal (IC) spaces in nearly 94%–100% of cases. 2 , 5 , 6 IMAPs originate from the IMA, perforate the pectoralis major muscle, and overlie the fascia. 7 Division of the deep inferior epigastric artery (DIEA) pedicle to match the IMAP vessel diameter, the use of a mechanical coupler device for arterial microanastomosis, and using the superficial inferior epigastric artery flap (SIEA) or the superior gluteal artery perforator (SGAP) flap for better vessel match can overcome size discrepancy.…”

Section: Introductionmentioning

confidence: 99%

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A Systematic Review and Meta-analysis of Clinical Outcomes in Autologous Breast Reconstruction Using Internal Mammary Artery Perforators as Recipient Vessels

Fernandez-Diaz

Christopoulos

Griffiths

2023

Plastic and Reconstructive Surgery - Global Open

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Background: Recipient vessel selection is vital for successful autologous free-flap breast reconstruction. Internal mammary artery perforators have gained interest as a recipient vessel option. However, previous studies on their microsurgical safety and efficacy are limited and inconsistent. Thus, we conducted a systematic review and meta-analysis to assess the safety and effectiveness of using internal mammary artery perforators as recipient vessels in breast reconstruction. Methods: The protocol has been previously published in PROSPERO (CRD42020190020). The PubMed, Scopus, Web of Science, and PROSPERO databases were searched. Two independent reviewers evaluated the articles for inclusion in the study. Study quality was assessed using the Newcastle-Ottawa Scale and the MINORS instrument (Methodological Index for Non-Randomized Studies). Results: Of the 361 articles screened, 13 studies were included (313 patients with 318 flaps; 223 unilateral, 31 bilateral, mean average age 51.2 and mean BMI 27.8 ± 1.9). The mean overall success rate was 99.8%, the pooled surgical success rate was 100% [95% confidence interval (CI): 97%–100%], and the overall rate of complications was 11% (95% CI: 7%–18%). The most common complication was vascular-related to microanastomoses, with an incidence of 5% (95% CI: 2%–10%). The fat necrosis rate was 3% (95% CI: 2%–6%). Conclusions: This study verified that internal mammary artery perforator vessels are reliable in breast reconstruction, with a high success rate and a relatively low complication rate. Moreover, in selected microsurgical breast reconstruction patients, internal mammary artery perforators may be the primary recipient vessel choice over the internal mammary artery or thoracodorsal vessels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Fernandez-diaz Et Al • Outcomes Of Imaps Breast Reconstructionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Systematic Review and Meta-analysis of Clinical Outcomes in Autologous Breast Reconstruction Using Internal Mammary Artery Perforators as Recipient Vessels

Fernandez-Diaz

Christopoulos

Griffiths

2023

Plastic and Reconstructive Surgery - Global Open

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Venous coupler use for free‐flap breast reconstructions: Specific analyses of TMG and DIEP flaps

Bodin¹,

Brunetti²,

Dissaux³

et al. 2014

Microsurgery

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Five recipient vessels for metachronous chest wall reconstruction: Case report and literature review

et al. 2015

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Selecting potential recipient vessel options for free flap anastomosis is an important consideration in microsurgical breast and chest wall reconstruction. In these settings, the most common comprise the internal mammary and thoracodorsal vessels, although alternative anastomotic sites have also been described. On occasion, consideration of these alternatives becomes a necessity. The use of five separate recipient vessels is highlighted in a unique case of recurrent locally advanced breast cancer requiring multiple complex reconstructions using free tissue transfer. A 56-year-old lady presented for delayed breast reconstruction one year after radical mastectomy for locally advanced lobular breast cancer. Despite wide resections, local chest-wall recurrence five times necessitated five microsurgical reconstructions, using separate recipient pedicles: internal mammary vessels, thoracodorsal vessels, serratus branch of thoracodorsal vessels, intercostal vessels and thoracoacromial vessels. All flaps survived completely, without donor or recipient complications. There has not been a subsequent recurrence at 6 months since last reconstruction. The purpose of this report is to present the first reported case of microsurgical chest wall reconstruction using five separate free flaps requiring anastomosis to multiple recipient vessels for anterior chest wall coverage, to present a literature-based and clinical review of the regional vascular anatomy of the anterior chest wall, and to present an operative approach algorithm. In such complex cases, this understanding can facilitate a streamlined approach to management. © 2014 Wiley Periodicals, Inc. Microsurgery 37:66-70, 2017.

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Internal mammary perforator vessels as recipient site for microsurgical breast reconstruction: A comparative histomorphometric analysis and incidence of degenerative vascular changes

Cited by 9 publications

References 45 publications

A Systematic Review and Meta-analysis of Clinical Outcomes in Autologous Breast Reconstruction Using Internal Mammary Artery Perforators as Recipient Vessels

A Systematic Review and Meta-analysis of Clinical Outcomes in Autologous Breast Reconstruction Using Internal Mammary Artery Perforators as Recipient Vessels

Venous coupler use for free‐flap breast reconstructions: Specific analyses of TMG and DIEP flaps

Five recipient vessels for metachronous chest wall reconstruction: Case report and literature review

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