Use of Internal Mammary Vessel Perforator as a Recipient Vessel for Free TRAM Breast Reconstruction

Abstract

Breast reconstruction is a cosmetically critical procedure for women and it must be undertaken to balance the shape, size, and position of the breast with the other breast. Since the first introduction of the free abdominoplasty flap in 1979, the transverse rectus abdominis musculocutaneous (TRAM) flap technique has been a widely accepted method of breast reconstruction after mastectomy. In breast reconstruction with a free flap, the selection of suitable recipient vessels is the critical decision to be made by the surgeon. The most common recipient vessel for free flap breast reconstruction is the axillary system. However, when used as a recipient, the axillary system may limit flap movement and flexibility in breast shaping. The use of the internal mammary vessels as a recipient site attains ideal breast symmetry. However, the technique requires partial rib resection and eliminates the opportunity for a potential coronary artery bypass graft, which requires the internal mammary artery. Based on these considerations, the selection of suitable recipient vessels constitutes an important requirement for successful free tissue transfer. The authors have performed breast reconstruction with the TRAM flap anastomosed to the internal mammary perforator vessel and conclude that these perforators could be useful as recipient vessels, especially in the case of immediate breast reconstruction with the free TRAM flap.

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

“…[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.…”

Internal Mammary Intercostal Perforators instead of the True Internal Mammary Vessels as the Recipient Vessels for Breast Reconstruction

“…[11][12][13][14][15] These previously published studies report utilization rates between 9 and 39 percent. [11][12][13][14][15] In those reports, use of the internal mammary perforator vessels was limited by inadequate vessels or by the procedure being technically infeasible.…”

“…[7][8][9][10] To minimize recipient-site morbidity, our group has attempted to refine further the use of the internal mammary perforator vessels for autologous flap reconstruction. Several previous studies have reported the use of the perforating branches but only in a limited number of patients [11][12][13][14] or, in larger series, with limited frequency. [11][12][13][14][15] These previously published studies report utilization rates between 9 and 39 percent.…”

“…Several previous studies have reported the use of the perforating branches but only in a limited number of patients [11][12][13][14] or, in larger series, with limited frequency. [11][12][13][14][15] These previously published studies report utilization rates between 9 and 39 percent. [11][12][13][14][15] In those reports, use of the internal mammary perforator vessels was limited by inadequate vessels or by the procedure being technically infeasible.…”

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

“…Measurements of the selected perforator were performed in two studies. Park et al 12 studied a series of five patients using the perforators as recipient vessels (four free TRAM flaps and one pedicle TRAM with perforator ''supercharge''), and reported an average arterial diameter of 1.56 mm and an average venous diameter of 1.4 mm. Hamdi et al 10 reported an average arterial diameter of 1 mm and venous diameter of 1.7 mm.…”