title: A clinical anatomic study of internal mammary perforators as recipient vessels for breast reconstruction.
abstract: BACKGROUND
  Partially resecting ribs of the recipient site to facilitate easy anastomosis of the internal mammary vessels to free flaps during breast reconstruction can cause chest wall pain or deformities. To avoid this, the intercostal perforating branches of the internal mammary vessels can be used for anastomosis. The purpose of this study was to investigate the location and size of the internal mammary perforator vessels based on clinical intraoperative findings and to determine their reliability as recipient vessels for breast reconstruction with microsurgical free tissue transfer.
  
  
  METHODS
  Twelve patients were preoperatively screened for the presence of internal mammary perforators using Doppler tracing. After modified radical mastectomy was performed by a general surgeon, the location and size of the internal mammary perforator vessels were microscopically investigated. The external diameter was examined using a vessel-measuring gauge from a mechanical coupling device, and the distance from the mid-sternal line to the perforator was also measured.
  
  
  RESULTS
  The largest arterial perforator averaged 1.5 mm, and the largest venous perforator averaged 2.2 mm. Perforators emerging from the second intercostal space had the largest average external diameter; the second intercostal space also had the largest number of perforators arising from it. The average distance from the mid-sternal line to the perforator was 20.2 mm.
  
  
  CONCLUSIONS
  Internal mammary perforators presented consistent and reliable anatomy in this study. Based on these results, the internal mammary perforators appear to have a suitable diameter for microvascular anastomosis and should be considered as an alternative recipient vessel to the internal mammary vessel.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: In-Soo
authors.initials: IS
authors.lastname: Baek
authors.forename: Jae-Pil
authors.initials: JP
authors.lastname: You
authors.forename: Sung-Mi
authors.initials: SM
authors.lastname: Rhee
authors.forename: Gil-Su
authors.initials: GS
authors.lastname: Son
authors.forename: Deok-Woo
authors.initials: DW
authors.lastname: Kim
authors.forename: Eun-Sang
authors.initials: ES
authors.lastname: Dhong
authors.forename: Seung-Ha
authors.initials: SH
authors.lastname: Park
authors.forename: Eul-Sik
authors.initials: ES
authors.lastname: Yoon
keywords: Breast neoplasms; Free tissue flaps; Mammary arteries; Mastectomy