Breast Necrosis Following Coronary by Pass Graft Surgery: Report of Two Cases &amp;amp; Review of Literature

Hadi, Maha Abdel; Ghonemi, Yasir; Regal, Mohammed; Shomimi, Saeed Al

doi:10.4236/wjcs.2013.37042

Cited by 2 publications

(3 citation statements)

References 12 publications

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“…However, with the development in endovascular surgery and minimal invasive procedures, the use of lined stents over long segments of the aorta and any major arteries causes occlusion of smaller arteries at their roots preventing the development of collaterals. In a subgroup of patients with atherosclerosis undergoing CABG surgery using IMA or inferior epigastric artery, the risk to develop chest wall and breast necrosis may increase 13. In this context, our patient's CT angiogram was able to identify long segments of linear calcification crossing both breast tissues, supportive of small vessel angiopathy, Figure3(D).…”

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First case report of bilateral breast necrosis following coronary artery bypass graft using left internal mammary artery

2021

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Coronary artery disease (CAD) is one of the most common public health problems worldwide. The overall prevalence of coronary artery disease in Saudi Arabia is 5.5%. 1 Coronary artery bypass graft surgery has gained momentum over the last years effectively treating CAD. Either arteries or veins can be used as conduits for coronary artery bypass graft (CABG) surgery. There are many sites that the conduit can be harvested from, including saphenous vein, left or right internal thoracic artery, radial artery, inferior epigastric artery, right gastroepiploic artery, and splenic artery. 2 The internal thoracic artery, also called internal mammary artery (IMA) graft, is currently the gold standard for myocardial revascularization. It offers long-term patency and provides a long conduit which resists atherosclerosis postimplantation. 3 Internal mammary artery grafts are not detached fully from their original site. IMA graft remains connected to its natural site of origin, and only one end is detached from the chest wall. This end is reattached to the coronary artery intended for the bypass Figure 1(A). 4 IMA gives out multiple vessels at the chest wall that supply the breast, sternum, mediastinum, and thymus. Although the breast is also supplied by the lateral mammary artery and the posterior intercostal branches of the Aorta, Figure 1(B), the IMA compromises the major source of breast vascularization (almost 60%) through the anterior intercostal perforators. 5,6 The harvesting of IMA in CABG procedure is associated with many complications. They are mostly wound related, ranging from skin dehiscence to complete avascular necrosis of the sternum. 7 Ipsilateral breast necrosis following CABG surgery is a rare incident due to the abundant vascularity of the breast and has been sporadically reported in the literature. However, contralateral breast necrosis after CABG procedure had not been reported in the literature up to date.Breast fat necrosis can result from different surgical, pathological, and traumatic causes. It usually presents as a breast lump which can imitate breast cancer. This is especially concerning in elderly patients where a higher probability of both breast cancer and CAD co-exist. The main clinical features of fat necrosis are hard palpable masses with irregular borders. In some cases, they can be tender and associated with skin tethering, bruising,

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“…7,9,11,12 Infarction is a rare incident that would require either occlusion of multiple large arteries or compromising small end arteries. 13 The patient we presented has lost the major blood supply to the breast coming medially through the perforator branches of the LIMA that was harvested during her CABG procedure. Figure 3(A).…”

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confidence: 99%

First case report of bilateral breast necrosis following coronary artery bypass graft using left internal mammary artery

2021

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“…We report sternal wound dehiscence and breast necrosis following a LIMA harvest during CABG. The sternal wound dehiscence following LIMA harvest is a known complication 1,2 but there are very few case reports of breast necrosis 4–17 following a CABG.…”

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confidence: 99%

Ischaemic breast necrosis following coronary artery bypass grafting using left internal mammary artery: understanding the risks

Sandeep

Khanna

Song

2021

ANZ Journal of Surgery

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Background Coronary artery bypass grafting (CABG) is a common procedure performed commonly using left internal mammary artery (LIMA). We report a case of sternal wound dehiscence and breast necrosis following LIMA harvest in a 55‐year‐old obese lady with macromastia, diabetes mellitus, hypertension and end stage renal disease requiring dialysis. We also review the existing literature. Methods Publications were identified from Medline All, Web of Science Core Collection, Google Scholar and Cochrane Central Register of Controlled Trial between 1974 and 2 January 2020. We assessed patient co‐morbidities, presentation time frame, quadrant of breast necrosis and reconstruction option utilized. Results There were 18 cases of breast necrosis reported post‐CABG. The patients were aged 50 or over, morbidly obese and had large tubular breasts. Other risk factors included chronic renal insufficiency, diabetes and hypertension. The presentation was delayed with necrosis only evident 7 days or more after CABG. All the reported cases had necrosis at lower inner quadrant of the left breast with nipple‐areola complex. Conclusion Blood supply to the breast is segmental with considerable overlap, however, this overlap is reduced in large breasts. Patients with macromastia and multiple co‐morbidities need preoperative imaging (computed tomography angiogram) to evaluate breast vascularity prior to CABG. Risk of breast necrosis needs to be explained during the informed consent. Surgical management of the hypermastia (breast reduction or amputation) may be a factor in facilitating the CABG procedure if indeed the LIMA is absolutely indicated considering the risks and benefits.

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Breast Necrosis Following Coronary by Pass Graft Surgery: Report of Two Cases & Review of Literature

Cited by 2 publications

References 12 publications

First case report of bilateral breast necrosis following coronary artery bypass graft using left internal mammary artery

First case report of bilateral breast necrosis following coronary artery bypass graft using left internal mammary artery

Ischaemic breast necrosis following coronary artery bypass grafting using left internal mammary artery: understanding the risks

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