Modified breast reconstruction using end-to-side anastomosis helps preserve the internal mammary artery for future use in coronary artery bypass graft (CABG), according to a new study.

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) reviewed the medical records of 22 consecutive patients of one surgeon who underwent 30 autologous breast reconstructions, and whose deep inferior epigastric artery perforator or superficial inferior epigastric artery-flap pedicles were joined by anastomosis. Half the procedures were performed using an arterial end-to-side hand-sewn technique, and the other half using an end-to-end hand-sewn technique. The researchers then compared both in terms of associated ischemia time, flap weight, incidence of thrombosis and fat necrosis, and overall flap survival.

The two patient groups did not differ with respect to age, body mass index (BMI), or other baseline characteristics. Eleven patients had immediate reconstruction, eight had staged procedures, and three had delayed reconstruction. An analysis of outcomes showed that mean ischemia time was the only significant difference between the groups. Ischemia time averaged 85.26 minutes with end-to-side anastomosis versus 64.4 minutes with end-to-end anastomosis. Mean flap weight, flaps with thrombosis, and flaps with fat necrosis did not differ significantly. The study was published in the October 2011 issue of Plastic and Reconstructive Surgery.

“Although the ischemia times were increased in the end-to-side group, they remained within acceptable limits,” concluded lead author Gedge Rosson, MD, and colleagues of the department of plastic surgery. “Therefore, this technique is a reliable and technically feasible method of preserving the internal mammary artery system for future potential cardiac surgery.”

The internal mammary artery has several advantages for microvascular breast reconstruction, including the need for a shorter pedicle than is required to reach the thoracodorsal arteries, facilitation of medial placement of flap tissue, and the avoidance of axillary scarring. It has also become the vessel of choice for CABG surgery due to its accessibility, superior patency versus vein grafts, and overall efficacy. Conventional approaches to breast reconstruction after treatment for invasive breast cancer often sacrifice the internal mammary artery as a result of the end-to-end anastomosis.
 

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