Internal Mammary Artery and Vein as Recipient Vessels for Microvascular Breast Reconstruction: Are We Burning a Future Bridge?

Clinical applications for the internal mammary artery include use as an arterial conduit for coronary revascularization and as a recipient artery for microvascular reconstruction of the breast. The purpose of this reported study was to resolve the controversy over which indication should have priority.

Six hundred twenty-five women with breast cancer who had reconstruction were reviewed. Of these, 288 were 50 years of age or greater, evaluated for cardiac disease, and included in this study. Three components were studied that included analysis of factors related to cardiac function (prior cardiac surgery, specific cardiac disorders, and cardiac medications), analysis of risk factors related to cardiac disease (hypertension, diabetes mellitus, and tobacco use), and analysis of factors related to the reconstruction (selection of recipient vessels, type of reconstruction). The women were stratified based on age: 50–59 years, 60–69 years, and greater than 70 years, to analyze trends based on advancing age.

The percentage of women with underlying cardiac disorders increased with advancing age and included 7.6% of women between 50 and 59 years, 13.9% of women between 60 and 69 years, and 21.1% of women who were at least 70 years of age. Of these CAD was documented in 3 of 288 women (0.69%). The percentage of women who had prior cardiac operations also increased with advancing age and was 0.5% when between 50 and 59 years, 2.8% when between 60 and 69 years, and 5.5% in the group at least 70 years of age. The internal mammary vessels were used in 57 of 138 free tissue transfers with no adverse sequelae. The 2 women with CAD were reconstructed with implants.

Based on the results of this study, it appears that use of the internal mammary artery as a recipient vessel for microvascular reconstruction of the breast is justified. The incidence of CAD in women with breast cancer who have had reconstruction is 0.69%. The incidence of factors related to cardiac function and the incidence of risk factors related to cardiac disease appeared to increase with advancing age. Options for coronary revascularization following use of the IMA as a recipient vessel include the opposite IMA when available, a saphenous vein graft, or angioplasty.