Use of the Internal Mammary Artery Perforator, No Rib Resection

The internal mammary artery has become the vessel of choice for microsurgical breast reconstruction. It has become popular because the position the of the vessel allows the flap to be positioned on the chest at a more medial position, versus the more lateral position of the lateral thoracic vessels. If you study the breast mound position, you will find that medial placement of the mound is more important than lateral placement.

The main issue with the use out of this vessel are twofold. #1. It requires removal of rib cartilage and deeper dissection into the thoracic cavity to gain access to this vessel. This sometimes leaves an indentation on the chest wall where the rib was removed. #2. The left internal mammary artery is a common source vessel for coronary artery bypass surgery to revascularize the heart. This means that in some rare cases, if this vessel has been used for breast reconstruction, it is no longer available for heart bypass surgery.

It is our philosophy that we should try to avoid use of this vessel when possible. We have been able to find, in a majority of our cases, the perforating artery and vein to the internal mammary vessel. This has shortened our operating time as well as avoiding the issues discussed above with removable are written and use of the main source vessel for coronary artery bypass surgery. We have been able to identify this vessel with ultrasound techniques as well with finesse, microsurgical dissection.