J Reconstr Microsurg
DOI: 10.1055/s-0040-1715878
Original Article

A Cadaveric Anatomical and Histological Study of Recipient Intercostal Nerve Selection for Sensory Reinnervation in Autologous Breast Reconstruction

1  Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
Marissa Suchyta
1  Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
Krishna S. Vyas
1  Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
Nirusha Lachman
2  Department of Anatomy, Mayo Clinic, Rochester, Minnesota
Samir Mardini
1  Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
Michael Saint-Cyr
3  Division of Plastic Surgery, Baylor Scott and White Health, Temple, Texas
› Author Affiliations
Funding This study received part funding from AxoGen, Inc. (grant no. FP00083113).


Background Autologous breast reconstruction (ABR) has grown in popularity due to improved aesthetic and long-term patient reported outcomes, but data regarding sensory reinnervation of autologous flaps remain limited. Traditionally, the lateral cutaneous branch of the fourth intercostal nerve has been used for flap neurotization, but the use of the anterior cutaneous branch of the intercostal nerves (ACB) offer a more optimal location to the microsurgical field when using internal mammary vessels for the microanastomosis. This study aimed to evaluate the optimum ACB recipient site level for sensory nerve coaptation in ABR.

Methods Twelve hemi-chests were dissected from six fresh cadaveric females. Costal cartilages were removed and the anterior cutaneous intercostal nerve (ACB) and the lateral (subcutaneous) division of the anterior cutaneous branch (LACB) of the intercostal nerve were exposed. Anatomical measurements were recorded, and nerve samples were evaluated histologically with carbonic anhydrase staining to differentiate sensory fascicles. Assessment of fascicular diameter, axonal counts, and fascicular area were compared.

Results A total of 75 nerve specimens were assessed. The ACB was identified at all levels (100%) and the subcutaneous LACB was noted consistently in the second to fourth rib space (96% cadavers), with a median length of 43, 37.5, and 37 mm, respectively. Across all rib spaces, the fascicular and axonal counts were comparable between the LACB and ACB. Nerves in the second intercostal space had a significantly larger mean fascicular area mean (112,816 ± 157,120 µm2) compared with that in the fourth (mean 26,474 ± 38,626 µm2), p = 0.03. Axonal count of sensory fascicles was the highest in the second intercostal nerves (p < 0.05).

Conclusion This study provides anatomical and histological basis to determine the optimum recipient site choice for sensory coaptation in microsurgical breast reconstruction. This would aid in operative decision-making regarding the ideal recipient anterior cutaneous intercostal nerve branches for recipient site coaptation in ABR.


This work was presented at the American Society of Reconstructive Microsurgery 2018.

Publication History

Received: 10 April 2020

Accepted: 15 July 2020

Publication Date:
30 August 2020 (online)

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