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Computed Tomographic Angiography Imaging and Clinical Implications of Internal Mammary Artery Perforator Vessels as Recipient Vessels in Autologous Breast Reconstruction

Fansa, Hisham MD, PhD*; Schirmer, Steffen MD*; Cervelli, Angelika MD; Gehl, Hans Björn MD, PhD

doi: 10.1097/SAP.0b013e31824e29c2

The internal mammary artery (IMA) is the standard recipient vessel for autologous breast reconstruction. To save the IMA for bypass surgery, to keep flap pedicles short, and to allow better flap positioning, the IMA perforators were used. Forty-six flaps for immediate breast reconstructions were performed in 39 patients. In the first 22 patients, the decision to use the perforators was clinically based. In the second group of 17 patients, all patients received a thoracic computed tomographic angiography (CTA) to determine the perforators. In 13 flaps (6 deep inferior epigastric artery perforator, 3 superficial inferior epigastric artery, and 4 transverse myocutaneous gracilis), the perforators were used as recipient vessels. Of these flaps, 5 were anastomosed to perforators before the CTA was applied and 8 after the CTA was established. The CTA revealed the IMA and the perforators in detail. In immediate reconstructions, the IMA perforators can be used as recipient vessels. They allow better flap positioning for superficial inferior epigastric artery and transverse myocutaneous gracilis flaps in particular; moreover, it decreases donor site and recipient site morbidity. After introducing the CTA, the perforators were used more frequently for anastomosis.

From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, †Breast Center, and ‡Department of Radiology, Klinikum Bielefeld, Bielefeld, Germany.

Received December 1, 2011, and accepted for publication, after revision, January 30, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Hisham Fansa, MD, PhD, Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Klinikum Bielefeld, Teutoburger Str. 50, 33604 Bielefeld, Germany. E-mail:

© 2013 by Lippincott Williams & Wilkins