RECIPIENT VESSELS IN FREE-FLAP BREAST RECONSTRUCTION - A STUDY OF THEINTERNAL MAMMARY AND THORACODORSAL VESSELS

The internal mammary vessels as recipient site for free flaps in breas t reconstruction were investigated in this paper because of their idea l location for breast reconstruction, Comparisons were made with the t horacodorsal vessels in terms of external vessel diameter, vessel size discrepancy, flap loss and reexploration rates, and ease of flap plac ement. Eighty-one patients underwent 110 breast free-flap reconstructi ons (92 TRAM, flaps and 18 superior gluteal flaps) between 1988 and 19 94. Vessel size measurements were available on 75 flaps. The internal mammary artery diameter (2.36 +/- 0.50 mm, n = 51) was significantly l arger than the thoracodorsal artery diameter (1.79 +/- 0.34 mm, n = 23 ; p < 0.001). There was no significant difference between the diameter s of the internal mammary vein (2.6 +/- 0.58 mm, n = 52) and thoracodo rsal vein (2.51 +/- 0.50 mm, n = 23; p = 0.93). The light internal mam mary artery (2.52 +/- 0.51 mm) was significantly larger than the left internal mammary artery (2.30 +/- 0.55 mm; p = 0.046). The right inter nal mammary vein (2.89 +/- 0.56 mm) also was significantly larger than the left internal mammary vein (2.31 +/- 0.48 mm; p = 0.002). In term s of vessel size discrepancy, the internal mammary recipient artery te nded to be greater in size than the TRAM flap donor artery (p = 0.003) , while the thoracodorsal recipient artery tended to be smaller than t he TRAM flap donor artery (p = 0.002), Flap failures and flap reexplor ations occurred in the group using the thoracodorsal vessels but not i n the internal mammary group, Correct flap placement using the interna l mammary recipient site was achieved more easily for both unilateral and bilateral reconstructions because of the avoidance of lateral full ness and medial deficiency problems. The internal mammary recipient si te is an important and at times superior alternative to the axillary r ecipient site because of its larger artery, especially when the axilla is scarred. For smaller free flaps such as a hemi-TRAM flap, as in bi lateral TRAM flap reconstructions, the internal mammary site is invalu able because this recipient site allows exact placement of a smaller f lap in the breast area.