Breast reconstruction with microsurgical free composite tissue transplantation

Harashina, Takao; Imai, Tatsuro; Nakajima, Hideo; Fujino, Toyomi

doi:10.1016/0007-1226(80)90048-x

Cited by 38 publications

(17 citation statements)

References 6 publications

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“…But after radiotherapy, these vessels tend to be small and vulnerable. In 1980, Harashina et al (20) reported that the IMA can be used in breast reconstruction with a free groin flap. Hefel et al (3) reported that with their predictable anatomy and adequate size, the IMA is a suitable artery for free tissue transfer in reconstructive surgery of the thoracic region, especially in breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

The anatomic evaluation of internal mammarian artery by using multidetector CT angiography

Karaman¹,

Battal²,

Bozkurt³

et al. 2011

Diagn Interv Radiol

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Section: Discussionmentioning

confidence: 99%

The anatomic evaluation of internal mammarian artery by using multidetector CT angiography

Karaman¹,

Battal²,

Bozkurt³

et al. 2011

Diagn Interv Radiol

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“…6,8 Described in 1947 by Longmire for microvascular esophageal reconstruction, the internal mammary vessels are becoming a reliable alternative. 12 Important articles were published by Harashina et al 13 using the groin flap and Shaw 14 using the gluteal superior free flap for breast reconstruction, emphasizing the importance of the medial vascular pedicle as a recipient site in flap mound position.…”

Section: Clinical Studymentioning

confidence: 98%

Perforator Flap Breast Reconstruction Using Internal Mammary Perforator Branches as a Recipient Site: An Anatomical and Clinical Analysis

Munhoz

Ishida

Montag

et al. 2004

Plastic and Reconstructive Surgery

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A variety of useful recipient sites exist for breast reconstruction with free flaps, and correct selection remains a significant decision for the surgeon. Among the main pedicles, the disadvantages of the internal mammary vessels are the necessity of costal cartilage resection and the impairment of future cardiac bypass. This study was designed to reduce morbidity and to seek alternative recipient vessels. In the anatomical part of the study, 32 parasternal regions from 16 fresh cadavers were used. The locations and components of internal mammary perforator branches were measured and a histomorphometric analysis was performed. In the clinical part of the study, 36 patients underwent 38 deep inferior epigastric perforator (DIEP) flap and two superior gluteal artery perforator flap breast reconstructions (31 immediate and four bilateral). The recipient vessels were evaluated. In the anatomical study, there were 22 perforating vessels, with 14 (63.6 percent) on the second intercostal space and 11 (50 percent) with one artery and vein. The average (+/-SD) internal and external perforator artery diameters were 598.48 +/- 176.68 microm and 848.97 +/- 276.68 microm, respectively. In the clinical study, 13 successful anastomoses (32.5 percent) were performed at the internal mammary perforator branches (second and third intercostal spaces) with 12 DIEP flaps and one superior gluteal artery perforator flap (all performed as immediate reconstructions). One case of intraoperative vein thrombosis and one case of pedicle avulsion during flap molding were observed. The anatomic and clinical studies demonstrated that the internal mammary perforator branch as a recipient site is a further refinement to free flap breast reconstruction. However, it is neither a reproducible technique nor potentially applicable in all patients. Preoperative planning between the general surgeon and the plastic surgeon is crucial to preserve the main perforator branches during mastectomy. The procedure was not demonstrable in late reconstructions. The main advantages of internal mammary perforator branches used as recipient sites are sparing of the internal mammary vessels for a possible future cardiac surgery, prevention of thoracic deformities, and reduction of the operative time by limited dissection. Despite this, limited surgical exposure, caliber incompatibility, and technical difficulties have to be considered as the main restrictions.

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“…9 -11 Use of the internal mammary artery and vein as recipient vessels for free tissue transfer was first reported in 1980. 13 The advantages, based on the vascular anatomy, of the internal mammary vessels as opposed to other recipient vessels in the vicinity such as the thoracodorsal have been described. 8,14 -18 The diameter of the internal mammary vessels at the level of the fourth rib ranges from 0.99 to 2.55 mm for the artery and 0.64 to 4.45 mm for the vein.…”

Section: Discussionmentioning

confidence: 99%

The Internal Mammary Artery and Vein as Recipient Vessels for Microvascular Breast Reconstruction:

Nahabedian

2004

Annals of Plastic Surgery

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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. This study was completed in an attempt to resolve the controversy over which indication should have priority. Five hundred twenty women with breast cancer who underwent breast reconstruction were reviewed. Of these, 240 were 50 years of age or more and were evaluated for cardiac disease. 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 to 59 years, 60 to 69 years, and older than 70 years-to analyze trends based on advancing age. Results demonstrated that the incidence of coronary artery disease was 2 in 240 women (0.8%) and that the incidence of factors related to cardiac function and the incidence of risk factors related to cardiac disease appear to increase with advancing age. The internal mammary vessels were used in 35 of 114 free tissue transfers with no adverse sequelae. No woman in whom the internal mammary artery was used has developed coronary artery disease. The 2 women with coronary artery disease were reconstructed with implants. Based on the results of this study, the author thinks that use of the internal mammary artery as a recipient vessel for microvascular reconstruction of the breast is justified. Options for future coronary revascularization would include the opposite internal mammary artery when available, a saphenous vein graft, or angioplasty.

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Breast reconstruction with microsurgical free composite tissue transplantation

Cited by 38 publications

References 6 publications

The anatomic evaluation of internal mammarian artery by using multidetector CT angiography

The anatomic evaluation of internal mammarian artery by using multidetector CT angiography

Perforator Flap Breast Reconstruction Using Internal Mammary Perforator Branches as a Recipient Site: An Anatomical and Clinical Analysis

The Internal Mammary Artery and Vein as Recipient Vessels for Microvascular Breast Reconstruction:

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