title: The retrograde limb of the internal mammary vein: an additional outflow option in DIEP flap breast reconstruction.
abstract: BACKGROUND
  The deep inferior epigastric perforator (DIEP) flap has become an increasingly popular option for postmastectomy reconstruction. The purpose of this study was to evaluate the retrograde limb of the internal mammary vein as a recipient vein in DIEP breast reconstruction.
  
  
  METHODS
  Fifteen consecutive DIEP flaps in 13 patients were transferred with anastomosis of one DIEP vena comitans to the antegrade internal mammary vein and the other DIEP vena comitans to the retrograde internal mammary vein. The deep inferior epigastric artery was anastomosed to the antegrade internal mammary artery. Blood flow through the retrograde internal mammary vein was evaluated with intraoperative duplex ultrasound.
  
  
  RESULTS
  Thirty venous anastomoses in 15 DIEP flaps for breast reconstruction were performed over a 4-month period to investigate the retrograde limb of the internal mammary vein as a potential recipient vein. No evidence of intraoperative venous congestion was seen. Retrograde blood flow was demonstrated using intraoperative duplex imaging and clinical examination. All 15 flaps were successful.
  
  
  CONCLUSIONS
  The retrograde limb of the internal mammary vein is an option as a recipient vein in DIEP breast reconstruction. This outflow option may prove useful in cases with intraoperative congestion in a single vein flap, in cases with co-dominant superficial and deep venous systems, and in cases in which double-pedicle free flaps are used for unilateral breast reconstruction.
authors.affiliation: Salt Lake City, Utah; and Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, University of Utah Health Sciences Center; and Section of Plastic and Reconstructive Surgery, University of Chicago.
authors.forename: Mahlon A
authors.initials: MA
authors.lastname: Kerr-Valentic
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Gottlieb
authors.forename: Jayant P
authors.initials: JP
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D012039:Regional Blood Flow; D012086:Reoperation; D013524:Surgical Flaps / Q000098:blood supply*; D013909:Thorax / Q000098:blood supply; D018616:Ultrasonography, Doppler, Duplex; D014680:Veins / Q000601:surgery