Use of circumflex scapular vessels as a recipient pedicle for autologous breast reconstruction: A report of 40 consecutive cases

The use of the circumflex scapular pedicle as a recipient vessel for breast reconstruction in a series of 40 consecutive cases in 37 patients is repor ted. There were 3 bilateral reconstructions and 34 unilateral reconstructio ns. Twenty-one cases were immediate reconstructions, and 19 cases were seco ndary reconstructions. The diameter of the artery varied from 1.5 mm to 3 m m and systematically matched with the diameter of the epigastric artery. Th e artery was a branch of the subscapular system in 82.5 percent of cases (3 3 of 40). In 17.5 percent of cases (7 of 40), the artery was a direct branc h of the axillary artery. The length of available pedicle between the axill ary vessel and the distal part where it can be divided (on its division bet ween scapular and parascapular artery) was of 76 +/- 13 mm for the artery a nd 72 +/- 12 mm for the vein. The vein was unique in 77.5 percent of cases. The diameter was similar to the artery diameter when unique. There was a d ual venous system in 21 of 40 cases (52.5 percent) but in 15 cases (37.5 pe rcent), one of the two veins was dominant. In the seven cases for which the veins were dual and of equivalent diameter, the epigastric veins were also dual and allowed a second anastomosis. Clinically, the anastomosis was alw ays possible on the artery. In one case of reconstruction after Halstedt ma stectomy, no vein could be found, because all the veins had been ligated pr eviously. One venous thrombosis (2.5 percent) and one arterial thrombosis w ere experienced. Both were treated by revised anastomoses and did not compr omise late results. The circumflex scapular pedicle is a reliable and simpl e recipient site for breast reconstruction. It allows a unique site of diss ection in immediate reconstruction and avoids division of the thoracodorsal pedicle. The technique is now used exclusively at this institution.