Demystifying the use of internal mammary vessels as recipient vessels in free flap breast reconstruction.
BACKGROUND
The internal mammary vessels are commonly used as primary recipient vessels for free flap breast reconstruction. However, there is debate about the reliability of the left internal mammary vein. The authors explored the anatomy of the internal mammary vessels as revealed during free flap breast reconstruction to determine whether microvascular complications differed between the left and right sides.


METHODS
All free flap breast reconstructions performed using internal mammary recipient vessels at the authors' institution between January of 2000 and December of 2010 were reviewed. The authors compared left and right breast reconstructions for internal mammary vessel diameters and microvascular complications, pedicle thrombosis, and total flap losses.


RESULTS
Overall, 1773 free flap breast reconstructions were performed in 1336 patients using the internal mammary vessels: 899 unilateral and 437 bilateral. The left side was used in 904 cases and the right side in 869 cases. Although the mean sizes of the left and right internal mammary arteries (2.44 and 2.47 mm, respectively) did not differ significantly, the left vein was significantly smaller than the right vein (2.47 mm versus 2.93 mm; p = 0.038). The overall rate of venous thrombosis was significantly higher on the left than on the right (3.0 percent versus 2.3 percent; p = 0.028). The rates of flap loss in left and right breast reconstructions did not differ significantly (1.9 percent versus 2.2 percent).


CONCLUSIONS
Although the left internal mammary vein is smaller than the right and is at higher risk for venous complications, it remains an acceptable recipient vessel for free flap breast reconstruction.


METHODS
Therapeutic, III.
Houston, Texas From the Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center.
Eric I
EI
Chang
Edward I
EI
Chang
Miguel A
MA
Soto-Miranda
Naveed
N
Nosrati
Geoffrey L
GL
Robb
David W
DW
Chang
D000714:Anastomosis, Surgical; D016121:Brachiocephalic Veins / Q000601:surgery; D019074:Epigastric Arteries / Q000601:surgery; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000601:surgery*; D008833:Microcirculation; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D014680:Veins / Q000601:surgery*; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control