title: Surgical technique: The intercostal space approach to the internal mammary vessels in 463 microvascular breast reconstructions.
abstract: The internal mammary vessels are one of the most frequently used recipient sites for microsurgical free-flap breast reconstruction, and an accepted technique to expose these vessels involves removal of a segment of costal cartilage of the rib. However, in some patients, cartilage removal may result in a visible medial chest-wall depression that requires corrective procedures. We, therefore, use an intercostal space approach to the internal mammary vessels, as there is minimal disturbance of the costal cartilage with this technique. We have developed and performed our technique over an 8-year period in 463 microvascular breast reconstructions, and present it here as it contains modifications not previously described that may be of interest to other surgeons. There was no serious morbidity associated with the intercostal space approach, the internal mammary vessels were reliably and safely exposed in all these cases and the flap success rate was 95.8%.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, 75185 Uppsala, Sweden.
authors.forename: Catharine M
authors.initials: CM
authors.lastname: Darcy
authors.forename: Jeroen M
authors.initials: JM
authors.lastname: Smit
authors.forename: Thorir
authors.initials: T
authors.lastname: Audolfsson
authors.forename: Rafael
authors.initials: R
authors.lastname: Acosta
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007366:Intercostal Muscles / Q000098:blood supply* / Q000601:surgery; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000601:surgery*; D008408:Mastectomy / Q000379:methods; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D012272:Ribs; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome