scholarly journals The Retrograde Limb of the Internal Mammary Artery: An Alternative Inflow Option for Free Flap Breast Reconstruction

2020 ◽  
Vol 25 (4) ◽  
pp. 326-330
Author(s):  
Hyung Min Hahn ◽  
Bohwan Cha ◽  
Il Jae Lee
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Internal Mammary Artery ◽  
Ductal Carcinoma ◽  
Perforator Flap ◽  
Autologous Breast Reconstruction ◽  
Epigastric Artery ◽  
Internal Mammary ◽  
Deep Inferior Epigastric Artery ◽  
Arterial Insufficiency

Autologous breast reconstruction using a free flap is a popular option for breast reconstruction after mastectomy. The internal mammary system is the recipient of choice in autologous breast reconstruction. We present our experience utilizing the caudal limb of the internal mammary artery as the recipient artery. A 44-year-old female patient with invasive ductal carcinoma in her right breast received total mastectomy and reconstruction with the deep inferior epigastric artery perforator flap was planned. During the operation, arterial insufficiency occurred three times; therefore, we decided to change the plan and to perform anastomosis to the caudal limb of the internal mammary artery. Retrograde blood flow of the internal mammary artery was successfully achieved. Immediate postoperative and long-term outcomes of the flap were satisfactory. This inflow option may be useful in cases with arterial insufficiency on conventional anastomosis or in cases with bipedicled or stacked flaps for unilateral breast reconstruction.

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

2020 ◽  
Author(s):  
Katherine D. Reuter Muñoz ◽  
Jeremy M. Powers ◽  
Shuhao Zhang ◽  
Santosh S. Kale
Keyword(s):  
Breast Reconstruction ◽  
Internal Mammary Artery ◽  
Vascular Anatomy ◽  
Autologous Breast Reconstruction ◽  
Obturator Artery ◽  
Anatomic Variant ◽  
Epigastric Artery ◽  
Internal Mammary ◽  
Deep Inferior Epigastric Artery ◽  
Flow Through

Abstract 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.

scholarly journals DIEAP Flap Breast Reconstruction Followed by Local Recurrence of Breast Cancer

2018 ◽  
Vol 11 (2) ◽  
pp. 493-498 ◽  
Author(s):  
Julia V.M. Huiskes ◽  
Mariël E. Keemers-Gels ◽  
Jan Fabré ◽  
Luc J.A. Strobbe
Keyword(s):  
Local Recurrence ◽  
Breast Reconstruction ◽  
Imaging Techniques ◽  
Perforator Flap ◽  
Autologous Breast Reconstruction ◽  
Sentinel Node Procedure ◽  
Palpable Mass ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Artery Perforator

Local recurrence after an autologous breast reconstruction is uncommon. We describe 2 patients with local recurrence 3 and 9 years, respectively, after mastectomy with DIEAP (deep inferior epigastric artery perforator) flap breast reconstruction. Patients generally present with a palpable mass, pain, or other visible abnormalities. Various imaging techniques are helpful, always completed by biopsy to characterize the tumour. A repeated sentinel node procedure can be useful in staging. The treatment of the local recurrence needs to be determined in a multidisciplinary team consultation.

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