Internal mammary artery perforators as recipient vessels in breast reconstruction with deep inferior epigas-tric perforator flap:a report of 18 cases
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)immedi-ately 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 Can-cer Hospital.The patients were 31 to 50 years old,with an average of 41.5 years old.The stages of breast cancer were cTis/1-2N0-2M0,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 pa-tients 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 in-tercostal 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 sur-vived.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 reli-able 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.
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