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AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
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The Internal Mammary Vessels as Recipient Site for Microsurgical Breast Reconstruction: 12 Year Review of 1,558 Cases, Lessons Learned and Technique Refinement

Joseph C. de Brux, Jr., M.D., Kirin Narra, MD, Ernest Chiu, MD, Mathew W. Wise, MD, Robert Allen, MD, Charles L. Dupin, MD.
LSU, New Orleans, LA, USA.

Purpose: The most common recipient vessels for free flap breast reconstruction have been the Internal Mammary vessels (IMV) and the Thoracodorsal vessels. There has been some discourse in the literature about the reliability of the Internal Mammary vessels (specifically the vein) as compared to the Thoracodorsal vessels. This paper will report our 12 year experience with over 1500 consecutive cases in which the Internal Mammary vessels were exclusively used as the recipient vessels. We believe this paper will demonstrate the reliability of these vessels and will describe some of the refinements in surgical technique learned during this series.
Methods: A 12 year retrospective chart review was performed using a prospectively maintained perforator flap breast reconstruction database. Recipient site location, recipient vessel quality, perforator flap utilized, flap loss, and other microsurgical complications were analyzed.
Results: From 1993-2004, 1558 perforator flaps were performed for microsurgical breast reconstruction. The Internal Mammary vessels were used in 97.2 percent of flaps (1515/1558). Alternate recipient vessels were used in the remaining 2.8 percent (43/1558). The Thoracodorsal system (n=16), internal mammary perforators (n=16), intercostal perforators (n=9), and cephalic vein (n=2) were used instead of the IMV in these cases. Complications included flap failure, pedicle kinking requiring flap re-insetting, arterial and venous thrombosis and injury to the underlying pleura. . IMV can be prepared with minimal donor site morbidity and complications. The central vessel location also allows two microsurgeons to perform anastomosis without difficulty. Conclusion: Based upon our experience, the Internal Mammary vessels should be considered the first choice as a recipient site for microsurgical breast reconstruction.

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