Download PDF
Semin Plast Surg 2002; 16(1): 109-118
DOI: 10.1055/s-2002-22688
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Internal Mammary Vessels as a Recipient Site for Free Flap Breast Reconstruction

Steven D. Vath, Charles L. Dupin, Robert J. Allen
  • Department of Plastic Surgery, Louisiana State University Medical Center, New Orleans, LA
Further Information

Publication History

Publication Date:
22 March 2002 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Breast reconstructive options are numerous. Since the advent of free tissue transfer breast reconstruction employing multiple donor possibilities, many factors have played a role in the evolution of optimizing both microsurgical success as well as flap insetting and the ultimate esthetic result. None of these are more important than the choice in recipient vessels for the microsurgical anastomoses. After the surgeon and patient decide upon the best-suited donor tissue and vessels for that individual, consideration is given to selecting the optimal recipient vessels. In free tissue breast reconstruction, the subscapular system has most frequently been used with good success.[1] [2] [3] The internal mammary system has been selectively used by some surgeons when the subscapular vessels are unavailable or inadequate and by others in defined patient groups, such as those undergoing delayed reconstruction.[1] [3] [4] We propose that the internal mammary vessels offer several advantages over the subscapular system and are an excellent primary choice as recipients for free tissue breast reconstruction. Our success in a large, consecutive series of 912 free tissue transfer breast reconstructions supports this premise.

KEYWORD

Internal mammary vessels - transverse rectus abdominus myocutaneous flap - deep inferior epigastric perforator flap

REFERENCES

  • 1 Grotting J C, Urist M M, Maddox W A. Conventional TRAM versus free microsurgical TRAM flap for immediate breast reconstruction.  Plast Reconst Surg . 1989;  83 828-841
    CrossrefPubMedGoogle Scholar
  • 2 Arnez Z M, Bajec J, Bardsley A F. Experience with 50 free TRAM flap breast reconsructions.  Plast Reconst Surg . 1991;  87 470-478
    CrossrefPubMedGoogle Scholar
  • 3 Ninkovic M, Anderl H, Hefel L. Internal mammary vessels: a reliable recipient system for free flaps in breast reconstruction.  Br J Plast Surg . 1995;  48 533-539
    CrossrefPubMedGoogle Scholar
  • 4 Serletti J M, Moran S L, Orlando G S. Thoracodorsal vessels as recipient vessels for free TRAM flap in delayed breast reconstruction.  Plast Reconst Surg . 1999;  104 1649-1655
    PubMedGoogle Scholar
  • 5 Hartrampf Jr R C, Scheflan M, Black P W. Breast reconstruction with a transverse abdominal island flap.  Plast Reconst Surg . 1982;  69 216-224
    CrossrefPubMedGoogle Scholar
  • 6 Fujino T, Harashina T, Aoyagi F. Reconstruction for aplasia of the breast and pectoral region by microvascular transfer of a free flap from the buttock.  Plast Reconst Surg . 1975;  56 178-181
    Google Scholar
  • 7 Fujino T, Harashina T, Enomoto K. Primary breast reconstruction after a standard radical mastectomy by a free flap transfer.  Plast Reconst Surg . 1976;  58 372
    PubMedGoogle Scholar
  • 8 Holmstrom H. The free abdominoplasty flap and its use in breast reconstruction.  Scand J Plast Reconst Surg . 1979;  13 423-427
    CrossrefPubMedGoogle Scholar
  • 9 Serafin D, Georgiade N G, Given K S. Transfer of free flaps to provide well-vascularized thick cover for breast reconstruction after radical mastectomy.  Plast Reconstr Surg . 1978;  62 527
    CrossrefPubMedGoogle Scholar
  • 10 Pennington D G. The rectus abdominis myocutaneous free flap.  Br J Plast Surg . 1980;  33 277
    CrossrefPubMedGoogle Scholar
  • 11 Shaw W. Microvascular free flap breast reconstruction.  Clin Plast Surg . 1994;  11 333-341
    PubMedGoogle Scholar
  • 12 Grotting J C. Immediate breast reconstruction using the free TRAM flap.  Clin Plast Surg . 1994;  21 207-221
    PubMedGoogle Scholar
  • 13 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle.  Br J Plast Surg . 1989;  42 645-648
    CrossrefPubMedGoogle Scholar
  • 14 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg . 1994;  32 32-38
    Google Scholar
  • 15 Allen R J, Tucker Jr C. Superior gluteal artery perforator free flap for breast reconstruction.  Plast Reconst Surg . 1995;  95 1207
    CrossrefPubMedGoogle Scholar
  • 16 Shaw W. Breast reconstruction by superior gluteal microvascular free flap without silicone implants.  Plast Reconst Surg . 1983;  72 490
    Google Scholar
  • 17 Blondeel P N, Boeckx W D. Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery.  Br J Plast Surg . 1994;  47 495-501
    Google Scholar
  • 18 Dupin C L, Allen R J, Glass C A. The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: a report of 110 consecutive cases.  Plast Reconst Surg . 1996;  98 685-689
    CrossrefPubMedGoogle Scholar
  • 19 Evans G RD, David C L, Loyer E M. The long-term effects of internal mammary chain irradiation and its role in the vascular supply of the pedicled transverse rectus abdominis musculocutaneous flap breast reconstruction.  Ann Plast Surg . 1995;  35 342-348
    CrossrefPubMedGoogle Scholar
  • 20 Ninkovic M M, Schwabegger A H, Anderl H. Internal mammary vessels as a recipient site.  Clin Plast Surg . 1998;  25 213-221
    PubMedGoogle Scholar
  • 21 Harashina T, Imai T, Nakajima H. Breast reconstruction with microsurgical free composite tissue transplantation.  Br J Plast Surg . 1980;  33 30-36
    CrossrefPubMedGoogle Scholar
  • 22 Ferro M, Novero D, Botto Micca F. Comparative morphological study of the structure of normal arteriosclerotic internal mammary, coronary and renal artery wall.  Pathologica . 1991;  83 159-166
    PubMedGoogle Scholar
  • 23 Majumder S, Batchelor A GG. Internal mammary vessels as recipients for free TRAM breast reconstruction: aesthetic and functional considerations.  Br J Plast Surg . 1999;  52 286-289
    CrossrefPubMedGoogle Scholar
  • 24 Feng L-J. Recipient vessels in free-flap breast reconstruction: a study of the internal mammary and thoracodorsal vessels.  Plast Reconst Surg . 1997;  99 405-416
    CrossrefPubMedGoogle Scholar
  • 25 Hefel L, Schwabegger A, Ninkovic M. Internal mammary vessels: anatomic and clinical considerations.  Br J Plast Surg . 1995;  48 527-532
    CrossrefPubMedGoogle Scholar
  • 26 Arnez Z M, Valdatta L, Tyler M P. Anatomy of the internal mammary veins and their use in free TRAM flap breast reconstruction.  Br J Plast Surg . 1995;  48 540-545
    CrossrefPubMedGoogle Scholar
  • 27 Clark C P, Rohrich R J, Copit S. An anatomic study of the internal mammary veins: clinical implications for free-tissue-transfer breast reconstruction.  Plast Reconst Surg . 1997;  99 400-404
    CrossrefPubMedGoogle Scholar
  • 28 Schwabegger A H, Ninkovic M M, Moriggl B. Internal mammary veins: classification and surgical use in free-tissue transfer.  J Reconst Microsurg . 1997;  13 17-32
    PubMedGoogle Scholar
  • 29 Schwabegger A H. Contour deformity at the internal mammary recipient site.  Br J Plast Surg . 1999;  52 674
    CrossrefPubMedGoogle Scholar
  • 30 Robb G L. Thoracodorsal vessels as recipient site.  Clin Plast Surg . 1998;  25 207-211
    PubMedGoogle Scholar