by Lee, Christina Dami;
Butterworth, James; Stephens, Robert E.; Wright, Barth; Surek, Christopher
Background:
Postmastectomy breast reconstruction provides psychosocial benefits in
self-esteem, sexuality, and quality of life. Autologous procedures yield the
highest overall patient satisfaction compared with implant-based breast
reconstruction as the gold standard. The internal mammary vessels are the
preferred recipient vessels for free flap breast reconstruction. The purpose of
this study is to provide surgeons with a reliable method for locating the
vessels intraoperatively. Methods: The internal mammary vessels were dissected
bilaterally on 30 cadaveric specimens. Distances from the lateral sternal
borders and the costochondral junctions to the internal mammary vessels at the
second, third, and fourth costal levels were recorded. Descriptive bifurcation
patterns were recorded. Initial dissection practicums were performed using the
proposed safer dissection zone according to quantitative data. Results: Sixty
internal mammary arteries and 120 internal mammary veins were studied at three
costal levels, resulting in 180 sets of measurements. Distances from the
lateral sternal border to the medial internal mammary vein were 6.12, 9.04, and
10.45 mm at costal levels 2, 3, and 4, respectively. Mean distances between
costochondral junctions and internal mammary arteries were 12.80, 24.78, and
33.28 mm at costal levels 2, 3, and 4, respectively. Most internal mammary vein
bifurcated at the third costal level, and the left side bifurcated higher than
the right. Dissection practicums revealed that the proposed dissection zone was
consistently reliable in locating the vessels. Conclusions: This study provides
mean measurements from common bony landmarks to the internal mammary vessels,
equipping surgeons with a reliable zone of dissection for recipient vessel
exposure. This may decrease morbidity and improve outcomes in autologous breast
reconstructions.
