The Lateral Thoracic Vessels: A Useful Recipient in Immediate Breast Reconstruction

Abstract

The recipient vessel is a critical factor for success in any microvascular reconstruction. Spatial and functional con-straints resulting from improper recipient vessel selection have significant impacts on reconstructive success and aesthetic outcome. The chest wall offers several options for anastomosis. The thoracodorsal 1–4 and internal mammary (IM) vessels are particularly well described. 5–7 However, these vessels may not always be available or suitable for anastomosis. While various modalities for preoperative evaluation of recipient vessels exist, they may not accurately evaluate the extent of vessel damage. Klein and colleagues found that radiotherapy does not always cause angiographic or macroscopically obvious damage to the IM vessels; hence, radiation-induced atherosclerosis of the IM arteries cannot always be detected preoperatively by digital subtraction angiography or even by intraoperative examination. Fur-thermore, a normal angiogram does not rule out surgical insufficiency of the IM vein. 8 As such, in patients who are undergoing secondary breast reconstruction after thoracic radiotherapy, preoperative angiography may not be a useful indication of vessel quality, and it may be necessary to use an alternate vessel should the thoracodorsal or IM vessels be unsuitable. With the increasing popularity of skin-and nipple-sparing mastectomy, 9 we believe that the lateral thoracic vessels are well suited for this role. They are centrally located and easily dissected, and allow for ideal positioning of the breast mound within the envelope of a skin-sparing mastectomy (►Fig. 1). Abstract Background Appropriate recipient vessel selection is a crucial aspect of microsurgical reconstruction. The chest wall presents several options for microvascular anastomosis, the most popular being the internal mammary and thoracodorsal vessels, although they may not always be available or suitable for breast reconstruction. We propose that the lateral thoracic vessels are a useful alternative, given their central position and intraoperative exposure in a skin-sparing mastectomy. Methods and Results We have performed four abdominal flaps based on the deep inferior epigastric artery and lateral thoracic vessels as the recipient vessels. The average diameter of the lateral thoracic artery was 2 mm and the vein was 2.75 mm. There were no vessel conversions, flap failures, or complications. Excellent aesthetic results were achieved. The anatomy of the lateral thoracic artery is described. Conclusion The lateral thoracic vessels are advantageous and safe recipient vessels. Their consistent anatomy, central location, and intraoperative exposure make them useful recipient vessels in breast reconstruction.