Distribution of Internal Thoracic Artery Perforators: A Clinical Anatomical Study

Introduction

There are various modifications of the transverse rectus abdominis musculocutaneous (TRAM) flap and deep inferior epigastric perforator (DIEP) flap to reduce the morbidity of the donor site or to augment the vascularity of the flap. For microanastomosis of multiple pedicles, multiple recipient vessels or an intervening vein graft should be provided. In addition, alternative perforator‐based flaps used in breast reconstruction have small caliber pedicles. Therefore, small recipient vessels such as internal thoracic artery perforators are more suitable for appropriate microanastomosis. Therefore, it is important to acquaint the distribution and anatomical characteristics of internal thoracic artery perforators.

Materials and Methods

We researched the perforators running in the intercostal spaces under the pectoralis major muscle to provide an overview of the anatomical distribution and characteristics of the perforators in patients who underwent immediate subpectoral implant‐based breast reconstructions.

Results

In our study, the major perforators (diameter > 1.5 mm) were easily found 2–7 cm medially between the third and fourth intercostal space (ICS) and were sparse in the lateral area from the midline of the breast (usually 8–9 cm lateral to the midsternal line) and above the third rib. In each side of the breast, the average number of perforators greater than 1.5 mm was 1.6, and the average number of perforators between 1 mm and 1.5 mm in diameter was 3.2.

Conclusion

Our results provide information about perforators in the anterior chest wall related to the breast area.

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