J Reconstr Microsurg 2010; 26(4): 219-223
DOI: 10.1055/s-0030-1248229
© Thieme Medical Publishers

Various Modifications to Internal Mammary Vessel Anastomosis in Breast Reconstruction with Deep Inferior Epigastric Perforator Flap

Chen-Kun Chen1 , Hao-Chih Tai2 , Hsiung-Fei Chien2 , Yueh-Bih Tang Chen2
  • 1Department of Plastic Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C
  • 2Department of Plastic Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan, R.O.C
Further Information

Publication History

Publication Date:
18 February 2010 (online)

ABSTRACT

Free autologous tissue transfer has been used in mastectomized patients for high-quality reconstruction. Since the deep inferior epigastric perforator flap was developed, it has been considered preferable owing to reduced donor site morbidity. At our institution, anastomosis of internal mammary vessels has been top priority because of better positioning and shorter pedicle length. We publish our experiences with various technical modifications that assure internal mammary vessel anastomosis. From 2003 to 2008, 35 patients received free deep inferior epigastric perforator flap for breast reconstruction by anastomosis with internal mammary vessels. Twenty-nine reconstructions were done immediately upon mastectomy whereas six were delayed. The patterns of anastomosis between the flap pedicle and internal mammary vessel were categorized and the results were followed by flap survival and complications. These deep inferior epigastric perforator flaps were all supplied by a single pedicle artery. Twenty-five of them were drained by a single pedicle vein, and the venous anastomosis pattern was end to end to the single internal mammary vein (IMV) (type I, n = 25). However, the other nine flaps were drained by one pedicle vein anastomosed end to end to double IMV (type II, n = 2), end to end to both proximal and distal ends of single IMV (type III, n = 5), end to end and end to side to single IMV (type IV, n = 2), and end to end to single IMV without anastomosing the other (type V, n = 1). All flaps were successful, except in one patient with type I anastomosis who received vascular reexploration due to pedicle twisting. Another patient with type I anastomosis needed revision due to partial fat necrosis of the flap. No other complications were found. Various modifications of internal mammary vessel anastomosis can be used to ensure the safety of deep inferior epigastric perforator flap in breast reconstruction.

REFERENCES

  • 1 Shaw W W. Microvascular free flap breast reconstruction.  Clin Plast Surg. 1984;  11 333-341
  • 2 Elliott L F, Hartrampf Jr C R. Breast reconstruction: progress in the past decade.  World J Surg. 1990;  14 763-775
  • 3 Beckenstein M S, Grotting J C. Breast reconstruction with free-tissue transfer.  Plast Reconstr Surg. 2001;  108 1345-1353 quiz 1354
  • 4 Gill P S, Hunt J P, Guerra A B et al.. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction.  Plast Reconstr Surg. 2004;  113 1153-1160
  • 5 Dupin C L, Allen R J, Glass C A, Bunch R. The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: a report of 110 consecutive cases.  Plast Reconstr Surg. 1996;  98 685-689 discussion 690-692
  • 6 Feng L J. Recipient vessels in free-flap breast reconstruction: a study of the internal mammary and thoracodorsal vessels.  Plast Reconstr Surg. 1997;  99 405-416
  • 7 Robb G L. Thoracodorsal vessels as a recipient site.  Clin Plast Surg. 1998;  25 207-211
  • 8 Lindsey J T. Integrating the DIEP and muscle-sparing (MS-2) free TRAM techniques optimizes surgical outcomes: presentation of an algorithm for microsurgical breast reconstruction based on perforator anatomy.  Plast Reconstr Surg. 2007;  119 18-27
  • 9 Rowsell A R, Davies D M, Eisenberg N, Taylor G I. The anatomy of the subscapular-thoracodorsal arterial system: study of 100 cadaver dissections.  Br J Plast Surg. 1984;  37 574-576
  • 10 Quaba O, Brown A, Stevenson H. Internal mammary vessels, recipient vessels of choice for free tissue breast reconstruction?.  Br J Plast Surg. 2005;  58 881-882
  • 11 Hamdi M, Blondeel P, Van Landuyt K, Monstrey S. Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: the role of the internal mammary perforators.  Br J Plast Surg. 2004;  57 258-265
  • 12 Haywood R M, Raurell A, Perks A GB, Sassoon E M, Logan A M, Phillips J. Autologous free tissue breast reconstruction using the internal mammary perforators as recipient vessels.  Br J Plast Surg. 2003;  56 689-691
  • 13 Majumder S, Batchelor A G. Internal mammary vessels as recipients for free TRAM breast reconstruction: aesthetic and functional considerations.  Br J Plast Surg. 1999;  52 286-289
  • 14 Park M C, Lee J H, Chung J, Lee S H. Use of internal mammary vessel perforator as a recipient vessel for free TRAM breast reconstruction.  Ann Plast Surg. 2003;  50 132-137

Yueh-Bih TangM.D. Ph.D. 

Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital

No. 7, Jhongshan S. Road, Jhongjheng District, Taipei 100, Taiwan

Email: phoebetang@ntu.edu.tw

    >