Selection of the recipient veins for additional anastomosis of the superficial inferior epigastric vein in breast reconstruction with free transverse rectus abdominis musculocutaneous or deep inferior epigastric artery perforator flaps.

There have been many methods to use the superficial inferior epigastric vein (SIEV) for improvement of flap circulation during breast reconstruction with free abdominal flap. If the SIEV is used for the purpose of adding another draining route, selection of ideal recipient vein is a crucial step. We reviewed our experiences of using the SIEV as additional vein in free transverse rectus abdominis musculocutaneous or deep inferior epigastric artery perforator breast reconstruction to find out the ideal recipient vein for SIEV. Between April 2006 and July 2010, 153 cases of breast reconstruction were performed using free transverse rectus abdominis musculocutaneous or deep inferior epigastric artery perforator flaps. Additional SIEV anastomosis was performed in 45 cases with risk factors. First choice of the recipient vein was the lateral thoracic vein if the SIEV was placed laterally after the inset of the flap. If the lateral thoracic vein was ablated with lymph node dissection, the branch of the thoracoacromial vein was selected. If the SIEV was placed medially, the perforator of the internal mammary vein was used. No vascular compromise was observed in cases with additional SIEV anastomosis with those recipient veins, whereas 9 cases of flap-related complications were observed in the remaining 108 cases without additional SIEV anastomosis. The incidences of the venous congestion were significantly different between the 2 groups. Combination of the lateral thoracic vein, branch of the thoracoacromial vein, and the perforator of the internal mammary vein provided an excellent choice of the recipient vein for the SIEV with reliability and availability.