J Reconstr Microsurg
DOI: 10.1055/s-0040-1717153
Original Article

Prevalence and Utilization of Obturator Artery Anatomic Variant in Autologous Breast Reconstruction

Katherine D. Reuter Muñoz
1  Virginia Commonwealth University School of Medicine, Richmond, Virginia
2  Division of Plastic and Reconstructive Surgery, Department of Surgery, Virginia Commonwealth University Health, Richmond, Virginia
Shuhao Zhang
3  Department of Plastic Surgery, Mercy Medical Group, Sacramento, California
Santosh S. Kale
4  Midwest Breast & Aesthetic Surgery, Columbus, Ohio
› Author Affiliations
Funding None.


Background The objective of this study is to quantify the prevalence and describe the utilization of an anatomic vascular variant in which the obturator artery (OA) arises from the trunk of the deep inferior epigastric artery (DIEA) in stacked/dual-pedicled autologous breast reconstruction. When this variant is identified preoperatively on computed tomography angiography (CTA), it may be utilized in a “flow-through” fashion to direct antegrade internal mammary artery (IMA) flow into a second free flap to facilitate anastomotic arrangement and optimize perfusion.

Methods Preoperatively obtained abdomen/pelvis CTA imaging of 121 autologous breast reconstruction patients were retrospectively reviewed for the unilateral or bilateral presence of the OA branch arising from the DIEA (OA variant). The results were analyzed using descriptive statistics.

Results Our analysis revealed the presence of the OA variant in 60 of the 121 (49.6%) breast reconstruction candidates, either unilaterally or bilaterally. Out of these patients, the variant was present unilaterally in 33 (55%) and bilaterally in 27 (45%) patients. Of the unilateral variants, 12 (36.4%) patients demonstrated right-sided laterality, while 21 (63.6%) patients demonstrated left-sided laterality. Clinically, this anatomic variant has been utilized in several cases of autologous breast reconstruction with flap survival in all cases.

Conclusion Utilization of this anatomic variant in stacked or dual-pedicled autologous breast reconstruction results in antegrade IMA perfusion of both primary and secondary flaps, as well as improved size match compared with other anastomotic options. Knowledge of the vascular anatomy and variations in the inferior epigastric system is crucial to both preventing complications and optimizing flap planning and outcome.

Publication History

Received: 01 June 2020

Accepted: 25 August 2020

Publication Date:
08 October 2020 (online)

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