A previous mastectomy does not increase sternal complications after coronary artery bypass grafting regardless of whether an internal mammary artery is used

Abstract

A mastectomy for breast cancer may alter the selection of grafts or the postoperative outcomes after coronary artery bypass grafting (CABG). To clarify these points, a retrospective analysis of patients who underwent CABG after a mastectomy was undertaken. A total of 19 mastectomy patients (13 left, 6 right, and 1 bilateral mastectomy) were identified prior to CABG, and their perioperative data as well as late outcomes were examined. The studied group consisted of all females with a mean age of 68.8 ± 6.2 years. The internal mammary artery (IMA) was used in 14 (73.7%) patients; however, there were no patients in whom bilateral IMAs were harvested. Among these 14 patients, an ipsilateral IMA was harvested in 6 and a contralateral IMA in 8. Alternative grafts were selected in 6 patients. A contralateral IMA or other graft conduits were utilized instead of an ipsilateral IMA. There were no in-hospital deaths or sternal wound complications. With a mean follow-up of 2.6 years, 3 patients died (1 cardiac death and 2 noncardiac deaths) and 1 patient developed angina due to de-novo coronary artery stenosis. In patients who have undergone a previous mastectomy, CABG using a single IMA is considered to be safe. If the IMA has good pulsation and if IMA harvesting is not difficult, even after a mastectomy, it can be used as a graft conduit without increasing the risk of sternal wound complications.