Summary
The most frequently described breast-sharing procedure consists in a pedicled technique
where the transferred lower breast pole is based on the lower perforators of the internal
mammary (IM) artery. The current article investigates the vascular supply of the breast
and its surgical implications in breast-sharing reconstruction.
Contrast-enhanced magnetic resonance images of 55 patients (110 breasts) were retrospectively
examined. A total of 473 branches of the IM, lateral thoracic (LT) and anterior intercostal
(AI) arteries with a diameter greater than 0.5 mm were traced throughout their course
in the breast. Distinct connections between the vessels were equally recorded.
Although any vessel could vascularise any quadrant in the individual patient, blood
supply to the lower quadrants came fundamentally from the AI arteries (76.2% of all
the perforators). Lower IM branches (4th-5th) were seen to reach both lower quadrants
in only 6.4% of the breasts, whereas LT branches did in 15.5%. In 86.4% of the breasts,
at least a distinct AI perforator was seen to perfuse both lower quadrants. Well-defined
connections between the IM and the LT arteries were observed in 41.8% of the breasts,
always at or above the nipple-areola level. Other connections were far less common.
Our study strongly indicates that the breast-sharing technique based on 4th-5th contralateral
branches of the IM or LT arteries is unreliable in most patients. Given the unpredictable
vascularization pattern in the lower breast pole, a preoperative imaging study is
mandatory when the use of the contralateral breast is considered. Due to its accuracy,
availability, and anatomical reliability, contrast-enhanced magnetic resonance is
the best technique in the preoperative evaluation of the breast-sharing reconstruction.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The Angiosome Concept and Tissue Transfer.Thieme Medical Publishers, 2013 (Incorporated)
- De l'autoplastie par glissement du sein.XII Congrès Francais De Chirurgie. 2. 1898: 225-227 (Paris)
- De l'autoplastie par déplacement de sein.Archives Générales de Médecine. 1903; 2: 2689-2698
- Chirurgie Réparatrice Et Corrective Des Téguments Et Des Formes.Masson et Cie, Paris1939
Reinhard W. In Thorek M, ed. Plastic Surgery of the Breast and Abdominal Wall. Springfield, Baltimore: Springfield, Ill., Baltimore, Md, C.C. Thomas, 1942.
- Automammaplasty.J Int Coll Surg. 1949; 12: 827-839
- The use of composite tube pedicle in the reconstruction of breast defect with subsequent cosmetic repair of the donor breast.Plast Reconstr Surg. 1950; 6: 396-399
- A method of reconstructing the breast.Br J Plast Surg. 1956; 9: 161-162
- New technique for breast reconstruction in unilateral amastia.in: Paper presented to the 9th Latin American Congress on Plastic Surgery in Sao Paulo. 1960
- Single stage reconstruction of the missing breast.Br J Plast Surg. 1973; 26: 377-380
- Post mastectomy breast reconstruction using a breast sharing technique.Br J Plast Surg. 1981; 34: 426-430
- Reconstruction mammaplasty using an economical flap from the opposite breast.Ann Plast Surg. 1981; 6: 374-380
- A new contralateral split-breast flap for breast reconstruction and its salvage after complication: An alternative for select patients.Ann Plast Surg. 2001; 47: 442-445
- Breast sharing: New perspectives on an old method.J Plast Reconstr Aesthet Surg. 2015; 68: 1727-1732
- Breast-sharing technique in a unilateral mastectomy patient.Plast Reconstr Surg Glob Open. 2018; 6: e1976
- Postmastectomy breast reconstruction using a microvascular breast-sharing technique.Plast Reconstr Surg. 2006; 118: 1313-1316
- Breast reconstruction with a lateral breast free flap: A new application of breast-sharing.Plast Reconstr Surg Glob Open. 2020; 8: e2701
- Arterial anatomy of the nipple-areola complex.Plast Reconstr Surg. 1995; 96: 843-845
- Vascular reliability of nipple-areola complex-bearing pedicles: An anatomical microdissection study.Plast Reconstr Surg. 2007; 119: 1167-1177
- A cadaver study of the vascular territories of dominant and nondominant internal mammary artery perforators.Ann Plast Surg. 2011; 67: 68-72
- The anatomic basis of the internal mammary artery perforator flap: A cadaver study.J Plast Reconstr Aesthet Surg. 2010; 63: 191-196
Manchot C. Die Hautarterien des menschlichen Körpers. Leipzig: F.C.W. Vogel. 1889.
- Mammary arteries.Q Bull Northwest U Med School. 1942; 16: 4
- The blood supply to the nipple-areola complex of the human mammary gland.Aesthetic Plast Surg. 2004; 28: 393-398
- Vertical Scar Mammaplasty.Springer Berlin Heidelberg, 2018
- Utilisation of contrast-enhanced magnetic resonance angiography in the assessment of deep inferior epigastric artery perforator flap for breast reconstruction surgery.Clin Radiol. 2019; 74: 445-449
Article info
Publication history
Published online: October 16, 2022
Accepted:
October 11,
2022
Received:
July 23,
2022
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
