Arch Plast Surg.  2019 Nov;46(6):599-602. 10.5999/aps.2019.00430.

Incidental finding of subclavian artery occlusion and subsequent hypoplastic internal mammary artery as a candidate recipient vessel in DIEP flap breast reconstruction

• Seong IH
• Woo KJ

• KMID: 2465562
• DOI: http://doi.org/10.5999/aps.2019.00430

Abstract

We report a case of autologous breast reconstruction in which a thoracodorsal vessel was used as a recipient vessel after a hypoplastic internal mammary vessel was found on preoperative computed tomography (CT) angiography. A 46-year-old woman with no underlying disease was scheduled to undergo skin-sparing mastectomy and breast reconstruction using a deep inferior epigastric artery perforator flap. Preoperative CT angiography showed segmental occlusion of the right subclavian artery with severe atherosclerosis and calcification near the origin of the internal mammary artery, with distal flow maintained by collateral branches. The thoracodorsal artery was selected to be the recipient vessel because CT showed that it was of adequate size and was not affected by atherosclerosis. The patient experienced no postoperative complications, and the flap survived with no vascular complications. The breasts were symmetrical at a 6-month follow-up. This case highlights that preoperative vascular imaging modalities may help surgeons avoid using diseased vessels as recipient vessels in free flap breast reconstructions.

Keyword

Breast reconstruction; Free flap; Subclavian artery; Internal mammary artery; Atherosclerosis

MeSH Terms

Angiography
Arteries
Atherosclerosis
Breast*
Epigastric Arteries
Female
Follow-Up Studies
Free Tissue Flaps
Humans
Incidental Findings*
Mammaplasty*
Mammary Arteries*
Mastectomy
Middle Aged
Perforator Flap
Postoperative Complications
Subclavian Artery*
Surgeons