title: Predictors of internal mammary vessel diameter: A computed tomographic angiography-assisted anatomic analysis.
abstract: The internal mammary vessels are the most common recipient vessels in free flap breast reconstruction. The literature on internal mammary vascular anatomy is limited by small sample sizes, cadaveric studies, or intraoperative changes. The purpose of this study is to analyze internal mammary anatomy using computed tomographic angiography. A retrospective review of 110 consecutive computed tomographic angiography studies of female patients was performed. Measurements of vessel caliber, distance of internal mammary vessels to sternum, location of internal mammary vein bifurcation, intercostal space height, and chest width were analyzed. Patient demographics and comorbidities were reviewed. The right internal mammary artery and vein were larger than the left in all intercostal spaces (p = 0.02 and p < 0.001, respectively). A significant correlation was found between both skeletal chest width and body mass index with internal mammary vessel caliber at the third intercostal space (p ≤ 0.02). The internal mammary vein bifurcated at the third intercostal space bilaterally, 4.3 and 1.2 mm caudal to the third rib on the right and left sides, respectively. The third intercostal space was <1.5 cm in 25% of patients. Understanding the anatomy, bifurcation, and caliber of internal mammary vessels can aid preoperative planning of autologous, free flap breast reconstruction. On average, the internal mammary vein bifurcates at the third intercostal space; patients with larger chest widths and body mass index had larger caliber internal mammary vessels, and 25% of patients had third intercostal space <1.5 cm and, thus, may not be suitable candidates for rib-sparing techniques.
authors.affiliation: Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, 545 Barnhill Drive, #232, Indianapolis, IN 46202, United States.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Cook
authors.affiliation: Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, 545 Barnhill Drive, #232, Indianapolis, IN 46202, United States; Division of Plastic & Reconstructive Surgery, R.L. Roudebush Veterans Administration Medical Center, 1481 West 10th Street, Indianapolis, IN 46202, United States.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Tholpady
authors.affiliation: Division of Plastic & Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite #400, Palo Alto, CA 94304, United States.
authors.forename: Arash
authors.initials: A
authors.lastname: Momeni
authors.affiliation: Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, 545 Barnhill Drive, #232, Indianapolis, IN 46202, United States. Electronic address: dr.michael.chu@gmail.com.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Chu
mesh_terms: D000328:Adult; D000886:Anthropometry / Q000379:methods; D001940:Breast / Q000098:blood supply; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology; D008953:Models, Anatomic
keywords: Breast reconstruction; Computed tomographic angiography; Free flap reconstruction; Internal mammary; Internal thoracic