title: Transverse Infraclavicular Approach to the Thoracoacromial Pedicle for Microsurgical Breast Reconstruction.
abstract: BACKGROUND
  In microvascular breast reconstruction, the internal mammary and thoracodorsal vessels are commonly used recipients. However, these vessels are sometimes compromised or unavailable. We hypothesize that a transverse infraclavicular (TIC) incision may provide efficient and reliable exposure to perform free flap anastomosis to the thoracoacromial (TAC) vessels for breast reconstruction.
  
  
  METHODS
  The authors present their results from a cadaveric feasibility study and a retrospective case series of 4 consecutive breast reconstruction patients in which the TIC-TAC approach was used.
  
  
  RESULTS
  The cadaveric dissection demonstrated a 5.5-cm pedicle length and a 3.75-mm diameter on the left side. On the right, the pedicle measured 5 cm in length and 4 mm in diameter. The dissection time was 10 minutes on the left side and 13 minutes on the right side. Five free flap breast reconstructions were performed in 4 patients using the TIC approach to the TAC artery which served as the primary recipient. The average pedicle length was 6.25 cm with a diameter of 3.55 mm. The pedicle was isolated and delivered through the infraclavicular incision in an average of 16.3 minutes on the left (n = 2) and 12.6 minutes on the right (n = 3). There were no complications, such as flap compromise or reoperation.
  
  
  CONCLUSIONS
  The TIC-TAC approach is feasible for microvascular breast reconstruction and can be considered for use by microvascular breast surgeons.
authors.affiliation: From the *Division of Plastic Surgery, Anne Arundel Medical Center, Annapolis; †Division of Plastic Surgery, University of Maryland, School of Medicine; and ‡Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Devinder P
authors.initials: DP
authors.lastname: Singh
authors.forename: Rachel
authors.initials: R
authors.lastname: Bluebond-Langner
authors.forename: Karan
authors.initials: K
authors.lastname: Chopra
authors.forename: Arvind U
authors.initials: AU
authors.lastname: Gowda
mesh_terms: D002968:Clavicle; D005240:Feasibility Studies; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies