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Demystifying the Use of Internal Mammary Vessels as Recipient Vessels in Free Flap Breast Reconstruction

Chang, Eric I. M.D.; Chang, Edward I. M.D.; Soto-Miranda, Miguel A. M.D.; Nosrati, Naveed M.D.; Robb, Geoffrey L. M.D.; Chang, David W. M.D.

Plastic and Reconstructive Surgery: October 2013 - Volume 132 - Issue 4 - p 763–768
doi: 10.1097/PRS.0b013e31829fe321
Breast: Original Articles

Background: The internal mammary vessels are commonly used as primary recipient vessels for free flap breast reconstruction. However, there is debate about the reliability of the left internal mammary vein. The authors explored the anatomy of the internal mammary vessels as revealed during free flap breast reconstruction to determine whether microvascular complications differed between the left and right sides.

Methods: All free flap breast reconstructions performed using internal mammary recipient vessels at the authors’ institution between January of 2000 and December of 2010 were reviewed. The authors compared left and right breast reconstructions for internal mammary vessel diameters and microvascular complications, pedicle thrombosis, and total flap losses.

Results: Overall, 1773 free flap breast reconstructions were performed in 1336 patients using the internal mammary vessels: 899 unilateral and 437 bilateral. The left side was used in 904 cases and the right side in 869 cases. Although the mean sizes of the left and right internal mammary arteries (2.44 and 2.47 mm, respectively) did not differ significantly, the left vein was significantly smaller than the right vein (2.47 mm versus 2.93 mm; p = 0.038). The overall rate of venous thrombosis was significantly higher on the left than on the right (3.0 percent versus 2.3 percent; p = 0.028). The rates of flap loss in left and right breast reconstructions did not differ significantly (1.9 percent versus 2.2 percent).

Conclusion: Although the left internal mammary vein is smaller than the right and is at higher risk for venous complications, it remains an acceptable recipient vessel for free flap breast reconstruction.


Houston, Texas

From the Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center.

Received for publication February 23, 2013; accepted April 9, 2013.

Presented at the 92nd Annual Meeting of the American Association of Plastic Surgeons, in New Orleans, Louisiana, April 20 through 23, 2013.

Disclosure: The authors have no financial interests to declare in relation to the content of this article.

Edward I. Chang, M.D., Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler Street, Unit 1488, Houston, Texas 77030,

©2013American Society of Plastic Surgeons