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Breast Necrosis Following Left Internal Mammary Artery Harvest: A Case Series and a Comprehensive Review of the Literature

Wong, Michael S. MD*; Kim, James MD*†; Yeung, Cecilia MD; Williams, Steven H. MD

doi: 10.1097/SAP.0b013e3181640851
Breast Surgery

Breast necrosis is a rare complication following coronary artery bypass grafting, as the blood supply to the breast is abundant. Internal mammary artery (IMA) harvest has been cited as a risk factor for breast necrosis following cardiac procedures. We retrospectively reviewed 3 cases of breast necrosis following IMA harvest, performed a comprehensive literature review, and noted risk factors. Obesity, macromastia, diabetes, hypertension, and end-stage renal disease were present in all cases. Two of 3 patients had pathology suggestive of calciphylaxis. Despite a rich blood supply, breast necrosis following use of the IMA for cardiac revascularization may occur in a subset of patients. Our review suggests that obese patients with macromastia and end-stage renal disease may be at increased risk for breast necrosis following IMA harvest. As the prevalence of obesity increases, we may see an increase in this previously uncommon complication.

From the *Division of Plastic Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, CA; †Division of Plastic Surgery, Department of Surgery, Kaiser Permanente Medical Center, Stockton, CA; and ‡Department of Pathology, University of California Davis Medical Center, Sacramento, CA.

Received July 27, 2007 and accepted for publication, after revision, December 3, 2007.

Reprints: Michael S. Wong, MD, University of California Davis Medical Center, Department of Surgery, Division of Plastic Surgery, 2221 Stockton Boulevard, Room 2123A, Sacramento, California 95817. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.