Bilateral DIEP Flap Breast Reconstruction to a Single Set of Internal Mammary Vessels

Background The purpose of this study was to compare the anatomical features of the internal mammary vessels (IMVs) at the second and third intercostal spaces (ICSs) with regard to their use as recipient vessels in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.Methods A total of 38 consecutive DIEP breast reconstructions in 36 patients were performed using IMVs as recipient vessels between March 2017 and August 2018. The intraoperative findings and postoperative complications were analyzed. Anatomical analyses were performed using intraoperative measurements and computed tomography (CT) angiographic images.Results CT angiographic analysis revealed the mean diameter of the deep inferior epigastric artery to be 2.42±0.27 mm, while that of the deep inferior epigastric vein was 2.91±0.30 mm. A larger mean vessel diameter was observed at the second than at the third ICS for both the internal mammary artery (2.26±0.32 mm vs. 1.99±0.33 mm, respectively; P=0.001) and the internal mammary vein (IMv) (2.52±0.46 mm vs. 2.05±0.42 mm, respectively; P<0.001). Similarly, the second ICS was wider than the third (18.08±3.72 mm vs. 12.32±2.96 mm, respectively; P<0.001) and the distance from the medial sternal border to the medial IMv was greater (9.49±2.28 mm vs. 7.18±2.13 mm, respectively; P<0.001). Bifurcations of the IMv were found in 18.4% of cases at the second ICS and in 63.2% of cases at the third ICS.Conclusions The IMVs at the second ICS had more favorable anatomic features for use as recipient vessels in DIEP flap breast reconstruction than those at the third ICS.

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Versatility and Reliability of Internal Mammary Vessels as Recipient Vessels in DIEP Flap Breast Reconstruction: A Clinical and Radiological Study on the Antegrade and Retrograde Flow

Breast Reconstruction ◽

10.1007/978-3-319-18726-6_79 ◽

2016 ◽

pp. 821-835

Author(s):

Marzia Salgarello ◽

Giuseppe Visconti ◽

Liliana Barone-Adesi ◽

Alessandro Cina

Keyword(s):

Breast Reconstruction ◽

Diep Flap ◽

Retrograde Flow ◽

Radiological Study ◽

Internal Mammary ◽

Internal Mammary Vessels

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DIEP Flap Breast Reconstruction Complication Rate in Previously Irradiated Internal Mammary Nodes

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1625986 ◽

2018 ◽

Vol 34 (06) ◽

pp. 399-403 ◽

Cited By ~ 6

Author(s):

Shirley Shechter ◽

Ehud Arad ◽

Amir Inbal ◽

Or Friedman ◽

Eyal Gur ◽

...

Keyword(s):

Radiation Therapy ◽

Breast Reconstruction ◽

Control Group ◽

Diep Flap ◽

Study Group ◽

Fat Necrosis ◽

Internal Mammary Nodes ◽

Internal Mammary ◽

Delayed Breast Reconstruction ◽

Internal Mammary Vessels

Background Postmastectomy radiation therapy (PMRT) is a widely accepted treatment for locally advanced breast cancer. Some patients require additional boost radiation to the internal mammary nodes as the part of regional nodal irradiation (RNI). Delayed breast reconstruction with an autologous free flap using the internal mammary vessels for microvascular flap anastomosis is a common practice for these patients. The aim of our study was to evaluate the effect of RNI on autologous microvascular breast reconstruction. Patients and Methods A retrospective study was performed on 57 patients (69 flaps) undergoing deep inferior epigastric perforator (DIEP) flap for delayed breast reconstruction after radiation therapy. The study group included 37 patients (65%) who received PMRT and RNI to the internal mammary nodes. The control group included 20 patients (35%) who received PMRT alone. Early and delayed surgical complications, including wound complications, fat necrosis, and flap loss, were compared between the groups. Results The patient demographics in both groups were similar. Complication rate showed a higher trend in the study group for flap loss (8.3% versus 0%) and vascular anastomosis failure (5.6% versus 0%), but with no statistical difference (p = 0.54, 0.53, respectively). The control group showed a higher trend in fat necrosis (25% versus 8.3%, p = 0.11). Conclusions DIEP flap breast reconstructions with internal mammary vessels anastomosis should be performed with cautious in patients who had received RNI to internal mammary nodes because of potential added risk for surgical complications.

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