Short Transfer of Free Flaps for Breast Reconstruction Using Internal Mammary Artery Perforators as Recipient Vessels: A Prospective Consecutive Case Series

Introduction: The use of internal mammary perforators (IMP) as recipient vessels for flaps in breast reconstruction has previously been described. We present their utility and limitations as a first choice recipient vessels in a consecutive prospective case series.

Methodology and Material: All patients underwent free flap breast reconstructions in a 6 month period by a single surgeon were included in this analysis. A total of fifty two free flaps (38 immediate and 14 delayed) in 45 patients were included. The IMP was attempted to be used as the preferred recipient vessels in all cases.

Results: IMAP recipient vessels were used in 24 (46%) of cases. Other recipient vessels were: thoracodorsal 23 (44%); serratus anterior 2 (4%); circumflex scapular in 2 (4%) and internal mammary artery 1 (2%). Mean ischemia time was (Mean/SD) 111/32 minutes. Average flap weight was 424/186 g and pedicle length was 9/3 cm. There was one case of flap loss (2%), one case of hematoma (2%), two cases of skin necrosis (4%) and 5 cases of fat necrosis (10%). Return to theater rate was 10%. No statistically significant difference was noted between the IMAP and other group (Fisher’s exact test).

Conclusions: The IMP is a reliable and effective recipient pedicle that maximizes operative efficiency and reduces recipient site morbidity. We recommend its use as the recipient pedicle of choice in breast reconstruction.