Computed tomographic angiography imaging and clinical implications of internal mammary artery perforator vessels as recipient vessels in autologous breast reconstruction.

The internal mammary artery (IMA) is the standard recipient vessel for autologous breast reconstruction. To save the IMA for bypass surgery, to keep flap pedicles short, and to allow better flap positioning, the IMA perforators were used. Forty-six flaps for immediate breast reconstructions were performed in 39 patients. In the first 22 patients, the decision to use the perforators was clinically based. In the second group of 17 patients, all patients received a thoracic computed tomographic angiography (CTA) to determine the perforators. In 13 flaps (6 deep inferior epigastric artery perforator, 3 superficial inferior epigastric artery, and 4 transverse myocutaneous gracilis), the perforators were used as recipient vessels. Of these flaps, 5 were anastomosed to perforators before the CTA was applied and 8 after the CTA was established. The CTA revealed the IMA and the perforators in detail. In immediate reconstructions, the IMA perforators can be used as recipient vessels. They allow better flap positioning for superficial inferior epigastric artery and transverse myocutaneous gracilis flaps in particular; moreover, it decreases donor site and recipient site morbidity. After introducing the CTA, the perforators were used more frequently for anastomosis.

The transverse myocutaneous gracilis muscle flap: a fast and reliable method for breast reconstruction.

BACKGROUND: Autologous breast reconstruction is predominantly performed using free transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flaps. However, some patients are not suitable candidates for flaps from the lower abdomen. The transverse skin island of the gracilis muscle presents an additional option, as it includes tissue from the posterior upper thigh/lower buttock and thus delivers the amount of tissue necessary for breast reconstruction. METHODS: In 2007, the authors' unit performed 73 free flaps for breast reconstruction subsequent to carcinoma, implant-related capsular fibrosis, and breast asymmetry. The transverse myocutaneous gracilis flap was used 32 times. The ventral margin was the greater saphenous vein, and the posterior margin was the midline of the inferior gluteal fold. The skin island could be harvested to a width of up to 30 cm and a height of up to 10 cm. The donor site was closed primarily. RESULTS: Thirty-two flaps were performed in 20 patients. Mean follow-up was 6 months. Mean operating time was 220 minutes for unilateral and 325 minutes for bilateral cases. All flaps and donor sites healed uneventfully. An initially described "tight feeling" at the thigh ceased after 2 to 3 weeks. Persistent hypesthesia of the dorsal thigh was not noted. A major asymmetry of the thigh in unilateral transplantations was not apparent. After 6 months, all flaps were soft. CONCLUSIONS: The transverse myocutaneous gracilis flap is a safe, fast flap for reconstruction after benign and malignant breast disease. It combines a constant vascular pedicle with soft subcutaneous tissue that has breast-like characteristics.