Changing trends in recipient vessel selection for microvascular autologous breast reconstruction: an analysis of 1483 consecutive cases.
BACKGROUND
Over the years, the authors' preferred recipient vessels for microvascular autologous breast reconstruction have changed from the thoracodorsal to the internal mammary vessels.


METHODS
From 1994 to 2004, 1483 microvascular autologous breast reconstructions were performed in 1168 patients at the authors' institution. Potential factors involved in the selection of the recipient vessels were evaluated and compared between the thoracodorsal and internal mammary groups. Rates of recipient vessel unusability and flap-related complications were also analyzed and compared between the two groups.


RESULTS
The mean patient age was 48 years, and the mean follow-up time was 1.5 years. The vessel conversion rate was 2.8 percent for the thoracodorsal group and 1.9 percent for the internal mammary group. Preoperative radiotherapy and previous axillary node dissection were significantly associated with thoracodorsal vessel conversion (odds ratios, 4.7 and 2.6, respectively). The overall flap-related complication rate (12.6 percent versus 8.6 percent) and specific flap-related complications, including flap loss (2.6 percent versus 3.8 percent), vessel thrombosis (3.7 percent versus 5.0 percent), fat necrosis (4.5 percent versus 2.6 percent), infection (0.7 percent versus 0.7 percent), and hematoma (1.6 percent versus 1.9 percent), were comparable between the two groups, but the flap seroma rate was significantly higher in the thoracodorsal group (4.0 percent versus 0.7 percent; odds ratio, 4.2).


CONCLUSIONS
In the authors' experience, use of internal mammary vessels is safe, with low rates of vessel conversion and flap-related complications.
Saint-Cyr
Michel
M
Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
Youssef
Adel
A
Bae
Hyung Woon
HW
Robb
Geoffrey L
GL
Chang
David W
DW
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000639:trends; D008323:Mammary Arteries / Q000601:surgery; D008866:Microsurgery; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply*; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000639:trends