Internal mammary artery perforators as recipient vessels in breast reconstruction with deep inferior epigastric perforator flap: a report of 18 cases
10.3760/cma.j.cn441206-20231225-00112
- VernacularTitle:选择内乳动脉穿支作为受区血管的腹壁下动脉穿支皮瓣乳房再造18例
- Author:
Xilong GONG
1
;
Yue YANG
;
Xuhui GUO
;
Jiao ZHANG
;
Lina WANG
;
Dechuang JIAO
;
Zhenzhen LIU
Author Information
1. 郑州大学附属肿瘤医院（河南省肿瘤医院）乳腺科，河南省乳腺癌诊疗中心，郑州 450008
- Keywords:
Breast reconstruction;
Deep inferior epigastric perforator flap;
Internal mammary artery perforator;
CT angiography;
Microsurgical technique
- From:
Chinese Journal of Microsurgery
2024;47(3):267-272
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical application effect of internal mammary artery perforator (IMAP) as recipient vessels in breast reconstruction with deep inferior epigastric perforator flap (DIEPF) immediately after breast cancer surgery.Methods:From May 2020 to May 2023, a total of 18 patients with DIEPF breast reconstruction using IMAP as recipient vessels were selected from the Department of Breast Disease of Henan Cancer Hospital. The patients were 31 to 50 years old, with an average of 41.5 years old. The stages of breast cancer were cT is/1-2N 0-2M 0, and all of the patients received immediate breast reconstruction after the breast cancer surgery. The size of flaps were from 9.0 cm × 26.0 cm to 15.0 cm × 38.0 cm. Preoperative chest and abdominal wall CTA were performed to identify the location of intercostal space and the calibre of IMAP. Intraoperatively, the number of IMAP, the diameters of corresponding arteries and accompanying veins in the recipient site were recorded. All patients were included in the scheduled postoperative follow-up through outpatient clinic or via WeChat. The quality of flap survival was evaluated, the condition of breast appearance and recovery of the abdominal donor site were evaluated according to the breast cancer patient reported outcome measures (BREAST-Q). Results:All the 18 patients had the IMAP visualised in surgery, with 13 had the IMAP located at the second intercostal space and 3 at the third intercostal space. The other 2 patients were found with the IMAP located in both the second and third intercostal spaces, in which 1 was found that both of IMAP were suitable for anastomosis. It was also found that there was 1 accompanying vein in 15 breasts and 2 accompanying veins in 2 breasts. One breast had found without an accompanying vein. The diameters of arteries were 1.1 mm±0.1 mm and that of the veins were 1.8 mm±0.3 mm. The average follow-up period was 28 months, ranged from 6 to 40 months. Of the 18 flaps, 17 were completely survived. Venous compromise occurred in 1 flap due to extensive venous thrombosis, and it was replaced with a breast implant. No patient experienced concave deformities in the reconstructed breasts. Seventeen patients with an average BREAST-Q score of 94.4. One patient with a BREAST-Q score of 79.0.Conclusion:IMAP can serve as a reliable recipient vessel for immediate breast reconstruction with DIEPF after breast cancer surgery. With strict selection criteria, this technique could be put on further trials with larger sample size and multi-centres.
