Internal Mammary Perforators: A Cadaver Study

Gedge D. Rosson; Luther H. Holton; Ronald P. Silverman; Navin K. Singh; Maurice Y. Nahabedian

doi:10.1055/s-2005-871750

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2005; 21(4): 239-242
DOI: 10.1055/s-2005-871750

Internal Mammary Perforators: A Cadaver Study

Gedge D. Rosson¹ ^, ² , Luther H. Holton³ , Ronald P. Silverman³ , Navin K. Singh¹ , Maurice Y. Nahabedian¹

¹Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, University of Maryland School of Medicine. Baltimore, Maryland
²Dellon Institute for Peripheral Nerve Surgery, University of Maryland School of Medicine. Baltimore, Maryland
³Plastic and Reconstructive Surgery, University of Maryland School of Medicine. Baltimore, Maryland

Abstract

ABSTRACT

Microsurgeons currently employ the internal mammary artery and vein as recipient vessels for microvascular reconstruction of the breast with increasing frequency. Recent reports have demonstrated that the perforating branches of the internal mammary artery and vein can also be used as recipient vessels. The purpose of the following cadaver study was to determine the location and diameter of these internal mammary perforators and whether they are suitable as recipient vessels. Ten fresh cadavers were obtained for this project. Using a micrometer under loupe magnification, bilateral measurements were taken of the perforators from the first five interspaces. The largest arterial perforator averaged 1.74 mm in diameter and the largest venous perforator averaged 1.78 mm in diameter. The largest perforators were most commonly found in the second interspace. Based on the results of this study, the internal mammary perforators appear to have suitable diameter for microvascular anastomosis and should be considered.

KEYWORDS

Internal mammary perforators - breast reconstruction - recipient vessels

Full Text

References

REFERENCES

1 Robb G L. Thoracodorsal vessels as a recipient site. Clin Plast Surg. 1998; 25 207-211
2 Banic A, Boeckx W, Greulich M et al.. Late results of breast reconstruction with free TRAM flaps: a prospective multicentric study. Plast Reconstr Surg. 1995; 95 1195-1204 , discussion 1205-1206
3 Ninkovic M, Anderl H, Hefel L, Schwabegger A, Wechselberger G. Internal mammary vessels: a reliable recipient system for free flaps in breast reconstruction. Br J Plast Surg. 1995; 48 533-539
4 Hefel L, Schwabegger A, Ninkovic M et al.. Internal mammary vessels: anatomical and clinical considerations. Br J Plast Surg. 1995; 48 527-532
5 Arnez Z M, Valdatta L, Tyler M P, Planinsek F. Anatomy of the internal mammary veins and their use in free TRAM flap breast reconstruction. Br J Plast Surg. 1995; 48 540-545
6 Dupin C L, Allen R J, Glass C A, Bunch R. The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: a report of 110 consecutive cases. Plast Reconstr Surg. 1996; 98 685-689 , discussion 690-692
7 Schwabegger A H, Ninkovic M M, Moriggl B et al.. Internal mammary veins: classification and surgical use in free-tissue transfer. J Reconstr Microsurg. 1997; 13 17-23
8 Feng L J. Recipient vessels in free-flap breast reconstruction: a study of the internal mammary and thoracodorsal vessels. Plast Reconstr Surg. 1997; 99 405-416
9 Clark III C P, Rohrich R J, Copit S, Pittman C E, Robinson J. An anatomic study of the internal mammary veins: clinical implications for free-tissue-transfer breast reconstruction. Plast Reconstr Surg. 1997; 99 400-404
10 Ninkovic M M, Schwabegger A H, Anderl H. Internal mammary vessels as a recipient site. Clin Plast Surg. 1998; 25 213-221
11 Majumder S, Batchelor A G. Internal mammary vessels as recipients for free TRAM breast reconstruction: aesthetic and functional considerations. Br J Plast Surg. 1999; 52 286-289
12 Blondeel P N. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg. 1999; 52 104-111
13 Moran S L, Nava G, Behnam A B, Serletti J M, Behnam A H. An outcome analysis comparing the thoracodorsal and internal mammary vessels as recipient sites for microvascular breast reconstruction: a prospective study of 100 patients. Plast Reconstr Surg. 2003; 111 1876-1882
14 Guzzetti T, Thione A. Successful breast reconstruction with a perforator to deep inferior epigastric perforator flap. Ann Plast Surg. 2001; 46 641-643
15 Tutor E G, Auba C, Benito A, Rabago G, Kreutler W. Easy venous superdrainage in DIEP flap breast reconstruction through the intercostal branch. J Reconstr Microsurg. 2002; 18 595-598
16 Park M C, Lee J H, Chung J, Lee S H. Use of internal mammary vessel perforator as a recipient vessel for free TRAM breast reconstruction. Ann Plast Surg. 2003; 50 132-137
17 Haywood R M, Raurell A, Perks A G, Sassoon E M, Logan A M, Phillips J. Autologous free tissue breast reconstruction using the internal mammary perforators as recipient vessels. Br J Plast Surg. 2003; 56 689-691
18 Hamdi M, Blondeel P, Van Landuyt K, Monstrey S. Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: the role of the internal mammary perforators. Br J Plast Surg. 2004; 57 258-265
19 Munhoz A M, Ishida L H, Montag E et al.. Perforator flap breast reconstruction using internal mammary perforator branches as a recipient site: an anatomical and clinical analysis. Plast Reconstr Surg. 2004; 114 62-68
20 Palmer J H, Taylor G I. The vascular territories of the anterior chest wall. Br J Plast Surg. 1986; 39 287-299
21 Taylor G I. The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg. 2003; 30 331-342
22 Conacher I D, Doig J C, Rivas L, Pridie A K. Intercostal neuralgia associated with internal mammary artery grafting. Anesthesia. 1993; 48 1070-1071
23 Defalque R J, Bromley J J. Poststernotomy neuralgia: a new pain syndrome. Anesth Analg. 1989; 69 81-82

Gedge D RossonM.D.

Johns Hopkins University School of Medicine, Division of Plastic Surgery

J.H.O.C., 8th Floor, 601 North Caroline Street

Baltimore, MD 21287