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

Abstract

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.

Comparing the thoracodorsal and internal mammary vessels as recipients for microsurgical autologous breast reconstruction: A systematic review and meta‐analysis

“…Recipient vessel selection is critical for a successful microsurgical outcome during free flap transfer (Nahabedian, ). For free tissue transfer in breast reconstruction, an informal consensus appears to prevail amongst microsurgeons, that strongly favors the internal mammary (IM) vessels over the thoracodorsal (Td) vessels as first line recipient vessels for microsurgical anastomosis (Nahabedian, ; Temple, Strom, Youssef, & Langstein, ).…”

An Appraisal of Internal Mammary Artery Perforators as Recipient Vessels in Microvascular Breast Reconstruction—An Analysis of 515 Consecutive Cases

“…8 IMA usage has nevertheless been questioned mainly because of the fact that the artery may be needed for a possible coronary bypass. 9,10 Intercostal perforating vessels (IMA perforators [IMAPs]) from the IMA have already been described as recipient vessels for immediate breast reconstruction. 11–16 The superficial location allows a less invasive dissection and improves accessibility.…”

Usefulness of Stabilizer for Microanastomoses of Internal Thoracic Vessels during DIEP Flap Breast Reconstruction

“…For microanastomoses of the DIEP flap, internal mammary vessels and thoracodorsal vessels can be used as recipient vessels, but the use of the internal mammary vessels has been reported to be clearly justified and preferred because of the highly pressurized system, consistent location, ease of accessibility, and flap positioning. 4 We also prefer to use internal mammary vessels as recipient vessels, and these vessels were used as recipient vessels in all DIEP flap reconstruction cases in our institution. However, when using internal mammary vessels as recipient vessels, respiratory fluctuations may disturb surgeons, especially while viewing the vessels at high magnification during microanastomosis.…”

“…4 However, the vessels are small and require microanastomoses under high magnification power, and respiratory fluctuations often disturb surgeons' focus. Respiratory fluctuation causes continuous focus field shifts and could be one reason for decreased quality of precise microanastomoses.…”