Internal mammary perforator recipient vessels for breast reconstruction using free TRAM, DIEP, and SIEA flaps

Background: Use of internal mammary perforator recipient vessels may decrease recipient-site morbidity in free flap breast reconstruction. However, it is not known whether they are as reliable as the internal mammary vessels or whether their use would result in increased recipient-site complications. Methods: A retrospective study of all 686 lower abdominal free flap breast reconstructions performed during a 4-year period at the authors' institution identified 38 cases in which internal mammary perforator vessels were used. A subset of 114 of the 686 cases was studied in which patients were treated by a single surgeon, internal mammary perforator vessel use was attempted, and vessel measurements were taken intraoperatively. Results: Internal mammary perforator recipient vessels were used in 27 percent of cases attempted, 94 percent of which were located at the second or third intercostal space. Internal mammary perforator arteries were significantly smaller in diameter (1.9 mm) than internal mammary arteries (2.6 mm) (p < 0.0001). Despite this, the incidences of flap loss, fat necrosis, and mastectomy skin flap necrosis were not significantly different between the internal mammary and internal mammary perforator vessel groups. The internal mammary and internal mammary perforator veins were similar in diameter. Conclusions: To the authors' knowledge, this is the largest published series of internal mammary perforator vessels used as free flap recipient vessels. In selected cases, internal mammary perforator vessels can be used without increasing the risk of flap loss, fat necrosis, or mastectomy skin flap necrosis, and are equally reliable and require less invasive surgical dissection than internal mammary vessels. The use of internal mammary perforator vessels may safely minimize recipient-site morbidity.