Feasibility of internal mammary vessel use in breast reconstruction versus coronary artery bypass surgery: an anatomic, cadaveric evaluation.

BACKGROUND

Autologous free flap breast reconstruction using the internal mammary artery is common; however, its use may compromise treatment of occult coronary artery disease. The authors investigated whether internal mammary artery harvest for breast reconstruction is compatible with future use for coronary bypass.

METHODS

An anatomic analysis of 10 preserved female cadavers was performed. Internal mammary artery measurements, including the length from its origin to the third, fourth, and fifth intercostal spaces, were taken, and the minimum length required to reach the left anterior descending coronary artery was determined.

RESULTS

The left internal mammary artery reached the left anterior descending target at a mean length of 10.0 cm. The mean lengths to the left third, fourth, and fifth intercostal spaces were 8.2 cm, 11.3 cm, and 13.7 cm, respectively, on the left, and 7.6 cm, 10.7 cm, and 13.2 cm, respectively, on the right. The right internal mammary artery reached the left anterior descending target at a mean of 12.0 cm.

CONCLUSIONS

The left internal mammary artery was found to reach the estimated coronary target by the level of the fourth intercostal space consistently, while the right was more variable and required a greater length. If the fourth intercostal space was used to harvest the internal mammary artery, the length necessary for in situ coronary bypass surgery is preserved on the left, and may still be used as a free graft on the right.