ABSTRACT
Microsurgeons currently employ the internal mammary artery and vein as recipient vessels
for microvascular reconstruction of the breast with increasing frequency. Recent reports
have demonstrated that the perforating branches of the internal mammary artery and
vein can also be used as recipient vessels. The purpose of the following cadaver study
was to determine the location and diameter of these internal mammary perforators and
whether they are suitable as recipient vessels. Ten fresh cadavers were obtained for
this project. Using a micrometer under loupe magnification, bilateral measurements
were taken of the perforators from the first five interspaces. The largest arterial
perforator averaged 1.74 mm in diameter and the largest venous perforator averaged
1.78 mm in diameter. The largest perforators were most commonly found in the second
interspace. Based on the results of this study, the internal mammary perforators appear
to have suitable diameter for microvascular anastomosis and should be considered.
KEYWORDS
Internal mammary perforators - breast reconstruction - recipient vessels
REFERENCES
- 1
Robb G L.
Thoracodorsal vessels as a recipient site.
Clin Plast Surg.
1998;
25
207-211
- 2
Banic A, Boeckx W, Greulich M et al..
Late results of breast reconstruction with free TRAM flaps: a prospective multicentric
study.
Plast Reconstr Surg.
1995;
95
1195-1204
, discussion 1205-1206
- 3
Ninkovic M, Anderl H, Hefel L, Schwabegger A, Wechselberger G.
Internal mammary vessels: a reliable recipient system for free flaps in breast reconstruction.
Br J Plast Surg.
1995;
48
533-539
- 4
Hefel L, Schwabegger A, Ninkovic M et al..
Internal mammary vessels: anatomical and clinical considerations.
Br J Plast Surg.
1995;
48
527-532
- 5
Arnez Z M, Valdatta L, Tyler M P, Planinsek F.
Anatomy of the internal mammary veins and their use in free TRAM flap breast reconstruction.
Br J Plast Surg.
1995;
48
540-545
- 6
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
- 7
Schwabegger A H, Ninkovic M M, Moriggl B et al..
Internal mammary veins: classification and surgical use in free-tissue transfer.
J Reconstr Microsurg.
1997;
13
17-23
- 8
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
- 9
Clark III C P, Rohrich R J, Copit S, Pittman C E, Robinson J.
An anatomic study of the internal mammary veins: clinical implications for free-tissue-transfer
breast reconstruction.
Plast Reconstr Surg.
1997;
99
400-404
- 10
Ninkovic M M, Schwabegger A H, Anderl H.
Internal mammary vessels as a recipient site.
Clin Plast Surg.
1998;
25
213-221
- 11
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
- 12
Blondeel P N.
One hundred free DIEP flap breast reconstructions: a personal experience.
Br J Plast Surg.
1999;
52
104-111
- 13
Moran S L, Nava G, Behnam A B, Serletti J M, Behnam A H.
An outcome analysis comparing the thoracodorsal and internal mammary vessels as recipient
sites for microvascular breast reconstruction: a prospective study of 100 patients.
Plast Reconstr Surg.
2003;
111
1876-1882
- 14
Guzzetti T, Thione A.
Successful breast reconstruction with a perforator to deep inferior epigastric perforator
flap.
Ann Plast Surg.
2001;
46
641-643
- 15
Tutor E G, Auba C, Benito A, Rabago G, Kreutler W.
Easy venous superdrainage in DIEP flap breast reconstruction through the intercostal
branch.
J Reconstr Microsurg.
2002;
18
595-598
- 16
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
- 17
Haywood R M, Raurell A, Perks A G, 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
- 18
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
- 19
Munhoz A M, Ishida L H, Montag E et al..
Perforator flap breast reconstruction using internal mammary perforator branches as
a recipient site: an anatomical and clinical analysis.
Plast Reconstr Surg.
2004;
114
62-68
- 20
Palmer J H, Taylor G I.
The vascular territories of the anterior chest wall.
Br J Plast Surg.
1986;
39
287-299
- 21
Taylor G I.
The angiosomes of the body and their supply to perforator flaps.
Clin Plast Surg.
2003;
30
331-342
- 22
Conacher I D, Doig J C, Rivas L, Pridie A K.
Intercostal neuralgia associated with internal mammary artery grafting.
Anesthesia.
1993;
48
1070-1071
- 23
Defalque R J, Bromley J J.
Poststernotomy neuralgia: a new pain syndrome.
Anesth Analg.
1989;
69
81-82
Gedge D RossonM.D.
Johns Hopkins University School of Medicine, Division of Plastic Surgery
J.H.O.C., 8th Floor, 601 North Caroline Street
Baltimore, MD 21287