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Internal mammary perforator vessels as recipient site for microsurgical breast reconstruction: A comparative histomorphometric analysis and incidence of degenerative vascular changes
Author(s) -
Mendonça Munhoz Alexandre,
Ishida luis h.,
Montag Eduardo,
Saito Fábio L.,
Mendes Marcio,
Alves Hélio,
Gemperli Rolf
Publication year - 2014
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.22203
Subject(s) - tunica media , medicine , lumen (anatomy) , cadaver , breast reconstruction , tunica intima , anatomy , microsurgery , breast cancer , surgery , cancer , carotid arteries
Background In microsurgical breast reconstruction, an adequate selection of recipient vessels is crucial for a successful outcome. Although the internal mammary (IM) vessels offer an attractive option, the internal mammary perforator (IMP) vessels are becoming a reliable alternative. The purpose of this study is to investigate the external diameters, lumen area, and atherosclerotic lesions changes of the IMP, IM, and deep inferior epigastric (DIE) vessels through quantitative and qualitative histomorphometric analysis. Methods Ninety‐six vessels of bilateral IM, IMP, and DIE vessels from 16 fresh female cadavers were evaluated. Mean age was 54.06 ± 5.7 years. External diameters, lumen area, and degenerative changes of the tunica intimae and media were analyzed by qualitative histomorphometric analysis. Results Seventy‐one vessels (20 IM, 31 IMP, and 20 DIE vessels) were included in the final histological analysis. A statistically lower external diameters and lumen area were presented by the IMP. The DIE vessels showed a lower incidence (10%) of moderate and severe intimal layer degenerative changes ( P = 0.0589). The IMP and DIE vessels showed a lower incidence (9.4 and 25%, respectively) of major media layer degenerative changes ( P = 0.0001). No major arterial degenerative lesions were observed in the IMP arteries. Conclusion Although the IMP external diameters and lumen area were lower than the IM, the results of this study indicated that the tunica media layer in the IMP is less damaged than the other recipient vessels. The results of the comparative histological study permitted to describe additional advantages and disadvantages of using IMP as a recipient vessel for free flap breast reconstruction. © 2013 Wiley Periodicals, Inc. Microsurgery 34:217–223, 2014.