AAPS Home AAPS Annual Meeting
Annual Meeting Home
Program & Abstracts
Past & Future Meetings


Back to Annual Meeting Program


Demystifying the Internal Mammary Vessels as Recipient Sites in Free Flap Breast Reconstruction
Eric I. Chang, M.D., Edward I. Chang, M.D., Jesse C. Selber, M.D., Geoffrey L. Robb, M.D., David W. Chang, M.D..
MD Anderson Cancer Center, Houston, TX, USA.

Purpose: The internal mammary vessels are currently the primary recipient vessels for free flap breast reconstruction. There are reports of increased difficulty in utilizing the left internal mammary vein (IMV). We hypothesize that the left IMV is smaller and therefore at greater risk for microvascular complications.
Methods: All free flap breast reconstructions performed at a single academic institution between January 2000 and December 2010 were identified and reviewed. Microvascular complications, pedicle thrombosis, and total flap losses were evaluated.
Results: Overall, 1773 free flaps were performed in a total of 1336 patients. Eight hundred and ninety-nine patients underwent unilateral free flap breast reconstruction while the remaining 437 patients had bilateral reconstructions using the internal mammary vessels as the recipient sites. Patients who underwent free flap breast reconstruction utilizing an alternative recipient site were excluded from this study. The left IMV was used in 904 cases and the right side was used in 869 cases. Although the mean sizes of the left and right internal mammary arteries (2.44mm and 2.47mm, respectively) did not differ significantly, the left IMV (2.47mm) was significantly smaller than the right IMV (2.93mm; p=0.038). While the overall rates of anastomotic revisions (70/899 [7.7%] and 53/874 [6.1%]) did not differ significantly, the rate of venous thromboses for left breast reconstructions (45/70 [64%]) was significantly higher than the contralateral side (24/53 [45%]; p<0.028). Evaluation of these compromised flaps also demonstrated significantly smaller veins on the left side compared to the right (2.42mm vs. 2.97mm; p=0.034). Lastly there was no significant difference in the rates of flap loss when comparing right and left breast reconstructions.
Conclusions: The left IMV is significantly smaller compared to the right IMV and is at higher risk for venous complications, but remains an acceptable recipient vessel for free flap breast reconstruction. If the left IMV is less than 2.0mm, consideration should be given to using an alternate recipient vessel or supercharging the flap with an additional venous anastomosis if a large superficial inferior epigastric vein exists.


Back to Annual Meeting Program