Advantages and disadvantages of using the internal thoracic artery perforators as recipient vessels in autologous breast reconstruction—a narrative review

Abstract

The rates of breast reconstruction after mastectomy are rising each year. Autologous breast reconstruction using free tissue transfer is considered the gold standard reconstruction, especially with recent controversy surrounding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). During free tissue transfer, the flap vessels must be anastomosed to recipient vessels on the chest wall. There are multiple options of recipient vessels during microvascular breast reconstruction. Most commonly, the thoracodorsal vessels or the internal thoracic vessels [also known as the internal mammary (IM) vessels] are used as the recipient vessels for microvascular anastomosis of the free tissue transfer. Other second-line options include the thoracoacromial axis and the lateral thoracic vessels. The use of perforators of the internal thoracic vessels for free flap anastomosis during autologous breast reconstruction has been in use for almost twenty years. They are generally favoured over use of thoracodorsal vessels as they result in medialisation of the flap. In recent years, the use of perforators of the internal thoracic vessels has become popular. Great debate surrounds whether or not they should be used as recipient vessels as opposed to the conventional main vessels. In this article, we discuss the advantages and disadvantages of both techniques to guide the choice of reconstructive microsurgeons.