title: Breast necrosis following left internal mammary artery harvest: a case series and a comprehensive review of the literature.
abstract: Breast necrosis is a rare complication following coronary artery bypass grafting, as the blood supply to the breast is abundant. Internal mammary artery (IMA) harvest has been cited as a risk factor for breast necrosis following cardiac procedures. We retrospectively reviewed 3 cases of breast necrosis following IMA harvest, performed a comprehensive literature review, and noted risk factors. Obesity, macromastia, diabetes, hypertension, and end-stage renal disease were present in all cases. Two of 3 patients had pathology suggestive of calciphylaxis. Despite a rich blood supply, breast necrosis following use of the IMA for cardiac revascularization may occur in a subset of patients. Our review suggests that obese patients with macromastia and end-stage renal disease may be at increased risk for breast necrosis following IMA harvest. As the prevalence of obesity increases, we may see an increase in this previously uncommon complication.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA. michael.wong@ucdmc.ucdavis.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wong
authors.forename: James
authors.initials: J
authors.lastname: Kim
authors.forename: Cecilia
authors.initials: C
authors.lastname: Yeung
authors.forename: Steven H
authors.initials: SH
authors.lastname: Williams
mesh_terms: D000368:Aged; D001940:Breast / Q000098:blood supply / Q000473:pathology* / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D003646:Debridement / Q000379:methods; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D009765:Obesity / Q000150:complications; D012086:Reoperation; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology