Autologous free tissue breast reconstruction using the internal mammary perforators as recipient vessels

Haywood, Richard M.; Raurell, Anna; Perks, A.G.B.; Sassoon, Elaine M.; Logan, A. M.; Phillips, John S.

doi:10.1016/s0007-1226(03)00206-6

Cited by 40 publications

(56 citation statements)

References 4 publications

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“…Need for rib resection may cause contour deformities and postoperative pain although this can be avoided through an intercostal approach to accessing the IMAs [9,14,31,99,118]. Other minimally invasive approaches have also been described [82].…”

Section: Disadvantagesmentioning

confidence: 99%

“…The additional advantages of using IMAPs compared with the IMAs include avoidance of the need to excise the ribs or costal cartilage to gain access the IMA, and in doing so also minimises operating time, post-operative pain, pulmonary complications and contour deformities (Table 2) [13,14,31,99,100]. The disadvantages of IMAPs centre on concerns over their reliability, availability, calibre and venous drainage.…”

Section: Technique 2: Using Ima Perforatorsmentioning

confidence: 99%

“…Bilateral procedures currently constitute around 10% of breast cancer operations and are becoming increasingly frequent with the greater use of BRCA gene testing and breast MRI [24][25][26][27][28][29]. Numerous studies have reported an increasing trend towards IMA-based breast reconstructions during the past 10-15 years (see Table 2) [13,14,[30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

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Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Rozen

Guio-Aguilar

et al. 2012

Breast Cancer Res Treat

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We outline five methods of preserving the IMA for future CABG: (1) lowering the level of DIEP flaps to the fourth- and fifth-intercostals spaces, (2) using the DIEP pedicle as an intermediary for CABG, (3) using IMA perforators to spare the IMA proper, (4) using and end-to-side anastomosis between the DIEP pedicle and IMA and (5) anastomosis of DIEP flaps using retrograde flow from the distal IMA. With careful patient selection, we hypothesize using the IMA for autologous breast reconstruction need not be an absolute contraindication for future CABG.

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Section: Disadvantagesmentioning

confidence: 99%

Section: Technique 2: Using Ima Perforatorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Rozen

Guio-Aguilar

et al. 2012

Breast Cancer Res Treat

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“…[3][4][5][6] This has naturally led to the use of perforating branches of internal mammary vessels as recipients for free flap breast reconstruction. [7][8][9][10][11] The advantages of using internal mammary perforator vessels over internal mammary vessels include simplified and less invasive recipient vessel preparation without the need to incise or excise pectoralis major muscle, costal cartilage, or intercostal muscle; and facilitation of microvascular surgery because of dampened respiratory and cardiac chest wall motion and more a more superficial location. We presume that these advantages result in decreased recipient-site morbidity.…”

mentioning

confidence: 99%

Internal Mammary Perforator Recipient Vessels for Breast Reconstruction Using Free TRAM, DIEP, and SIEA Flaps

Saint‐Cyr

Chang

Robb

et al. 2007

Plastic and Reconstructive Surgery

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To the authors' knowledge, this is the largest published series of internal mammary perforator vessels used as free flap recipient vessels. In selected cases, internal mammary perforator vessels can be used without increasing the risk of flap loss, fat necrosis, or mastectomy skin flap necrosis, and are equally reliable and require less invasive surgical dissection than internal mammary vessels. The use of internal mammary perforator vessels may safely minimize recipient-site morbidity.

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“…[8][9][10][11] Haywood et al 9 used the in-ternal mammary perforators as recipient vessels in 39% of consecutive flaps. In an independent study, Munhoz et al 11 used the IM perforators in a third of consecutive flaps over a 2-year time period.…”

mentioning

confidence: 99%

Free DIEP and SIEA breast reconstruction to internal mammary intercostal perforating vessels with arterial microanastomosis using a mechanical coupling device

2008

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Autologous breast reconstruction with microsurgical free tissue transfer has become routine, and perforator-based adipocutaneous flaps are recognized as an excellent option for many patients. Current efforts to optimize patient outcomes focus on minimizing operative morbidity both at the donor and recipient sites. The DIEAP flap avoids most of the abdominal wall morbidity associated with the TRAM. At the recipient site, however, partial rib resection, for access to the internal mammary (IM) artery and vein as recipient vessels, has a risk of chest wall pain, deformity, and pneumothorax. Perhaps more importantly, sacrifice of the IM vessels precludes their use for potential future coronary revascularization. To avoid this, the intercostal perforating branches from the internal mammary system may be used as recipient vessels for microanastomosis. This has been well described using suture technique, although the use of a mechanical coupling device for arterial anastomosis to the perforator has not been reported. We report nine cases whereby a mechanical coupling device was used to perform both the arterial and venous anastomoses of DIEAP and SIEA flap pedicles to IM intercostal perforating vessels. Flap ischemia time was shorter in all cases, allowed ease of anastomosis for vessel size mismatch, and is technically easier in deep wounds. This technique is a further refinement to free flap breast reconstruction and is a powerful application of the coupling device.

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Autologous free tissue breast reconstruction using the internal mammary perforators as recipient vessels

Cited by 40 publications

References 4 publications

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Internal Mammary Perforator Recipient Vessels for Breast Reconstruction Using Free TRAM, DIEP, and SIEA Flaps

Free DIEP and SIEA breast reconstruction to internal mammary intercostal perforating vessels with arterial microanastomosis using a mechanical coupling device

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