Summary
Introduction
Autologous free flap breast reconstruction is currently considered as the gold standard
in breast reconstruction as it provides a durable, natural result. The internal mammary
vessels are the most commonly used recipient vessels in free flap breast reconstruction,
and anecdotally we have often observed that the left internal mammary vein (IMV) appears
smaller than the right IMV. The aim of this study is to compare the diameters of the
right and left IMVs by recording the size of the venous coupler used on each side
in a large series of bilateral free flap breast reconstructions.
Methods
We searched our free flap database for patients who had breast reconstruction between
October 2018 and August 2021. Inclusion criteria for this study were bilateral breast
reconstruction patients, where the internal mammary vessels were used.
We used a paired t-test for statistical analysis of the data.
Results
A total of 105 patients who had bilateral breast reconstruction were included in this
study. Their mean age was 48.4 years. The mean venous coupler size used on the right
was 2.64 mm (SD 0.35), whilst the mean left IMV coupler size was 2.48 (SD 0.32). Using
a paired t-test, the p value for the comparison of the right and left IMV size in the cohort
was 0.00032, demonstrating a statistically significant difference.
Conclusion
We have confirmed that the right IMV is larger in diameter than the left side, and
demonstrated that this translates into a recordable practical difference in the coupler
size used. Despite this, we experienced no venous congestion or flap failures in our
left-sided flaps, indicating that the IMVs remain a safe choice of recipient vein.
Keywords
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References
- A systematic review of morbidity associated with autologous breast reconstruction before and after exposure to radiotherapy: are current practices ideal?.Ann Surg Oncol. 2014; 21: 1732-1738
- Overall Complication Rates of DIEP flap breast reconstructions in germany—a multi-center analysis based on the DGPRÄC prospective national online registry for microsurgical breast reconstructions.J Clin Med. 2021; 10
- Short-term safety outcomes of mastectomy and immediate implant-based breast reconstruction with and without mesh (iBRA): a multicentre, prospective cohort study.Lancet Oncol. 2019; 20: 254-266
- Choice of recipient vessels in muscle-sparing transverse rectus abdominis myocutaneous flap breast reconstruction: a comparative study.Arch Plast Surg. 2019; 46: 140-146
- Venous thrombosis in handsewn versus coupled venous anastomoses in 857 consecutive breast free flaps.J Reconstr Microsurg. 2015; 32: 178-182
- Does size matter: evaluating the difference between right and left internal mammary veins in free flap breast reconstruction.J Reconstr Microsurg. 2019; 35: 677-681
- Comparison of venous couplers versus hand-sewn technique in 4577 cases of DIEP -flap breast reconstructions – a multicenter study.Microsurgery. 2020;
- Microvascular coupler device versus hand-sewn venous anastomosis: a systematic review of the literature and data meta-analysis.Microsurgery. 2020; 40: 608-617
- Systematic review: anastomotic microvascular device.J Plastic Reconstr Aesthetic Surg. 2014; 67: 752-755
- Venous coupler size in autologous breast reconstruction-does it matter?.Microsurgery. 2013; 33: 514-518
- Comparison of the second and third intercostal spaces regarding the use of internal mammary vessels as recipient vessels in DIEP flap breast reconstruction: an anatomical and clinical study.Arch Plast Surg. 2020; 47: 333-339
- Smaller diameter anastomotic coupling devices have higher rates of venous thrombosis in microvascular free tissue transfer.Plast. Reconstr. Surg. 2017; 140: 1293-1300
- Microsurgical training opportunities at the queen victoria hospital: a retrospective review of 848 free flaps for breast reconstruction.Ann Plast Surg. 2020; 84: e27-e28
Article info
Publication history
Published online: October 16, 2022
Accepted:
October 11,
2022
Received:
May 19,
2022
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
