Free tissue transfer has become an accepted and reliable method of breast reconstruction.
In most cases, the internal mammary or thoracodorsal vessels are utilized as the standard
recipient vessels. The authors reviewed their series of venous outflow alternatives
in free breast reconstruction when the internal mammary and thoracododorsal veins
were deemed inadequate or unusable.
A retrospective review of all free breast reconstructive procedures at the Mayo Clinic
Scottsdale was performed from July 2003 through May 2005. The recipient vein chosen
for venous anastomosis was recorded. Outcomes were measured with regard to reexploration,
flap failure, and fat necrosis.
One hundred and thirteen free breast reconstructions were performed over a 2-year
period (95 deep inferior epigastric perforator flaps, 13 superficial inferior epigastric
artery flaps, 4 superior gluteal artery perforator flaps, 1 anterolateral thigh flap).
The internal mammary vessels were considered the first choice for recipient vessels
and were used in 104 cases. In four cases, the thoracodorsal vessels were used if
an axillary dissection had been performed or the internal mammary vessels were unsuitable.
In five cases, neither the internal mammary nor the thoracodorsal veins were suitable
and alternative venous outflow options were used, all of which occurred on the left
side. In these cases, the cephalic vein was used in four cases and the external jugular
vein used once. Seven flaps required reexploration due to anastomotic complications
(1 arterial thrombosis, 6 venous thromboses), all of which occurred in the left internal
mammary group, and 3 flaps failed. Fat necrosis occurred in 12 cases. All cephalic
and external jugular recipient veins remained patent with no flap failures or fat
necrosis in this group. Two patients in the cephalic vein group had known preoperative
lymphedema and were involved in a comprehensive lymphedema control program. Postoperatively,
neither patient was noted to have any change in their circumferential arm measurements
nor a change in their subjective lymphedema symptoms following cephalic vein transfer
for free breast reconstruction.
The cephalic vein or external jugular vein can be considered an excellent alternative
for venous outflow in free breast reconstruction if neither the internal mammary nor
thoracodorsal veins are deemed adequate or usable. These should be considered as acceptable
options especially in left-sided breast reconstructions where the internal mammary
veins can be particularly tenuous.
