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

Background Partially resecting ribs of the recipient site to facilitate easy anastomosis of the internal mammary vessels to free flaps during breast reconstruction can cause chest wall pain or deformities. To avoid this, the intercostal perforating branches of the internal mammary vessels can be used for anastomosis. The purpose of this study was to investigate the location and size of the internal mammary perforator vessels based on clinical intraoperative findings and to determine their reliability as recipient vessels for breast reconstruction with microsurgical free tissue transfer.

Methods Twelve patients were preoperatively screened for the presence of internal mammary perforators using Doppler tracing. After modified radical mastectomy was performed by a general surgeon, the location and size of the internal mammary perforator vessels were microscopically investigated. The external diameter was examined using a vessel-measuring gauge from a mechanical coupling device, and the distance from the mid-sternal line to the perforator was also measured.

Results The largest arterial perforator averaged 1.5 mm, and the largest venous perforator averaged 2.2 mm. Perforators emerging from the second intercostal space had the largest average external diameter; the second intercostal space also had the largest number of perforators arising from it. The average distance from the mid-sternal line to the perforator was 20.2 mm.

Conclusions Internal mammary perforators presented consistent and reliable anatomy in this study. Based on these results, the internal mammary perforators appear to have a suitable diameter for microvascular anastomosis and should be considered as an alternative recipient vessel to the internal mammary vessel.

Keywords

Mammary arteries - Free tissue flaps - Breast neoplasms - Mastectomy

Publication History

Received: 18 June 2013

Accepted: 30 July 2013

Article published online:
01 May 2022

• REFERENCES

• 1 Clark 3rd CP, Rohrich RJ, Copit S. et al. An anatomic study of the internal mammary veins: clinical implications for free-tissue-transfer breast reconstruction. Plast Reconstr Surg 1997; 99: 400-404
• 2 Arnez ZM, Valdatta L, Tyler MP. et al. Anatomy of the internal mammary veins and their use in free TRAM flap breast reconstruction. Br J Plast Surg 1995; 48: 540-545
• 3 Dupin CL, Allen RJ, Glass CA. et al. The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: a report of 110 consecutive cases. Plast Reconstr Surg 1996; 98: 685-689
• 4 Ninkovic M, Anderl H, Hefel L. et al. Internal mammary vessels: a reliable recipient system for free flaps in breast reconstruction. Br J Plast Surg 1995; 48: 533-539
• 5 Haywood RM, Raurell A, Perks AG. et al. Autologous free tissue breast reconstruction using the internal mammary perforators as recipient vessels. Br J Plast Surg 2003; 56: 689-691
• 6 Munhoz AM, Ishida LH, Montag E. et al. Perforator flap breast reconstruction using internal mammary perforator branches as a recipient site: an anatomical and clinical analysis. Plast Reconstr Surg 2004; 114: 62-68
• 7 Park MC, Lee JH, Chung J. et al. Use of internal mammary vessel perforator as a recipient vessel for free TRAM breast reconstruction. Ann Plast Surg 2003; 50: 132-137
• 8 Schmidt M, Aszmann OC, Beck H. et al. The anatomic basis of the internal mammary artery perforator flap: a cadaver study. J Plast Reconstr Aesthet Surg 2010; 63: 191-196
• 9 Saint-Cyr M, Chang DW, Robb GL. et al. Internal mammary perforator recipient vessels for breast reconstruction using free TRAM, DIEP, and SIEA flaps. Plast Reconstr Surg 2007; 120: 1769-1773
• 10 Hamdi M, Blondeel P, Van Landuyt K. et al. Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: the role of the internal mammary perforators. Br J Plast Surg 2004; 57: 258-265
• 11 Vesely MJ, Murray DJ, Novak CB. et al. The internal mammary artery perforator flap: an anatomical study and a case report. Ann Plast Surg 2007; 58: 156-161
• 12 Rosson GD, Holton LH, Silverman RP. et al. Internal mammary perforators: a cadaver study. J Reconstr Microsurg 2005; 21: 239-242
• 13 Lim SY, Song HS, Pae NS. et al. The anatomical study of internal mammary perforators. J Korean Soc Plast Reconstr Surg 2009; 36: 24-28