Evaluation of internal mammary perforators as a recipient vessels for deep inferior epigastric perforator flap delayed breast reconstruction in Egyptian population

Background
Nowadays, the standard practice in microsurgical reconstructive breast surgery is focusing on providing good esthetic outcome with minimal morbidity. Therefore, attention is no longer given to the donor site only but also to the recipient area. Thus, internal mammary perforators (IMPs) are adopted to be used as recipient vessels in autologous free flap breast reconstruction as it carries many advantages in comparison with the internal mammary, or thoracodorsal vessels. Our aim in this study was to evaluate the clinical reliability and to test the efficacy of using these perforators as recipient vessels in Egyptian population especially fatty patients coming after radiotherapy for delayed breast reconstruction.
Patients and methods
A prospective analysis was performed on 16 Egyptian patients who visited Ain Shams University hospitals over the course of 2 years, from September 2020 to September 2022.Deep inferior epigastric perforator flap breast reconstructions were performed by a single surgeon on all patients. The use of IMP vessels was attempted, and intraoperative measurements of the vessels and flaps were collected.
Results
All of the included patients underwent delayed breast reconstruction surgery. In four (25.0%) patients, IMP vessels were used. The subcutaneous plane (57.1%) is where the majority of the perforator vessels are situated. The third intercostal space held 64.3% of the perforator vessels, whereas the second held 35.7% of them. The diameter of IMPs was considerably less than that of internal mammary arteries. With the exception of one patient who needed debridement due to fat necrosis, all recipients were appropriate and trustworthy as recipient vessels without experiencing any serious morbidities such flap loss, fat necrosis, or mastectomy skin flap necrosis.
Conclusion
Despite their relatively small size, IMP vessels are trustworthy and safe to employ as recipient vessels in free flap breast reconstruction because they achieve a less-invasive procedure than using internal mammary vessels.