Approach to Internal Mammary Vessel without Rib Cartilage Resection in Free Abdominal Flap Breast Reconstruction.

Eom, Jin Sup; Sun, Sang Hoon; Kim, Tae Gon; Lee, Taik Jong

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2009;36(6):750-754.
Published online November 1, 2009.

Approach to Internal Mammary Vessel without Rib Cartilage Resection in Free Abdominal Flap Breast Reconstruction.

Jin Sup Eom, Sang Hoon Sun, Tae Gon Kim, Taik Jong Lee

¹Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. Jinsupp@amc.seoul.kr
²Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea.

Abstract

PURPOSE
The thoracodorsal vessels have been the standard recipient vessels for the majority of surgeons performing free abdominal flap breast reconstructions. Recently, the internal mammary vessels have been recommended as the first-choice recipient vessels for microvascular breast reconstruction. To approach the internal mammary vessel, 3rd or 4th rib cartilage excision is needed, but this method has some demerits such as vessel injury, post operative pain and post operative chest hollowness. So, authors propose the approach method to the internal mammary vessel through intercostal space without rib cartilage resection. METHODS: From November, 2008 to May, 2009, 13 patients underwent free abdominal flap breast reconstruction with approach to the internal mammary vessel through intercostal space without rib cartilage resection.
RESULTS
The mean patient age was 41.8 years, and the mean height was 159.3 cm. 11 patients underwent immediate breast reconstruction. Free DIEP flap reconstruction was performed in 7 patients, Free TRAM flap was performed in 5 patients, and Free SIEA flap was performed in 1 patient. Except 1 case, approach to the internal mammary vessel was took through 3rd intercostal space, and all width of intercostal space exceeded 1 cm.
CONCLUSION
In the authors' experience, use of approach to the internal mammary vessels without rib cartilage resection method is safe and reliable to overcome demerits of rib cartilage resection method.

Keywords: Breast reconstruction; Internal mammary artery

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