Internal mammary vessels as recipients for free TRAM breast reconstruction: aesthetic and functional considerations

The utilisation of the internal mammary vessels (IMVs) as recipient vessels for free TRAM reconstruction of the breast is well established. To gain ad equate access to the IMVs, a medial segment of the ipsilateral third costal cartilage is:usually excised. Concern has been expressed regarding potenti al complications specific to use of this site, including pneumothorax, inte rcostal neuralgia, chestwall herniae and contour defects. We present a retr ospective study of our experience with free TRAM breast reconstruction, usi ng the IMVs as recipient vessels, to ascertain the incidence of such compli cations. Twenty-five consecutive cases were studied. The clinical notes were analyse d for information regarding immediate and late complications. All the patie nts were recalled and underwent assessment and examination by the authors. There were no cases of haemo- or pneumothorax on the side of the reconstruc tion. There were no complaints of chest pain suggestive of intercostal neur algia. No discernible contour defects at the site of rib excision were foun d and no thoracic herniae were demonstrated. We suggest that internal mammary vessels can safely be used as recipients f or free TRAM reconstruction of the breasts with no:added aesthetic or funct ional morbidity.