title: Color duplex assessment of 4th and 5th internal mammary artery perforators: the pedicles of the medially based lower pole breast flaps.
abstract: OBJECTIVE
  Reconstruction of a breast after mastectomy using the contralateral lower pole breast flap is an appealing procedure because it uses the tissues that were going to be excised during reduction of the sound breast to achieve symmetry. Literature mentioned that these flaps are supplied by the lower internal mammary artery perforators (IMAPs) with no further details. The aim of this study was to determine the site, size, and number of the 4th and 5th IMAPs by using preoperative color Duplex ultrasound and intraoperative exploration.
  
  
  METHODS
  Twenty breasts in 10 patients who presented for reduction mammoplasty were included in this study. Preoperative color duplex was used to determine IMAPs in the 4th and 5th intercostal spaces. These perforators were localized intraoperatively. Intravenous fluorescein injection was used to determine the perfusion of the lower pole breast flap on the basis of these perforators.
  
  
  RESULTS
  Statistically, the 4th IMAPs diameters were significantly larger than the 5th IMAPs diameters (P < .05). The lower pole breast flap was perfused through these perforators.
  
  
  CONCLUSIONS
  Color Duplex ultrasound is an accurate tool to preoperatively determine the 4th and 5th IMAPs.
authors.forename: Kareem
authors.initials: K
authors.lastname: Abdel-Monem
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elshahat
authors.forename: Sherif
authors.initials: S
authors.lastname: Abou-Gamrah
authors.forename: Hossam
authors.initials: H
authors.lastname: Eldin Abol-Atta
authors.forename: Reda
authors.initials: R
authors.lastname: Abd Eltawab
authors.forename: Karim
authors.initials: K
authors.lastname: Massoud