Internal mammary vessels as a recipient site.

In breast reconstruction with a free flap, the selection of suitable recipient vessels remains one of the most critical decisions for the surgeon. Most surgeons use one of the branches of the axillary vascular system, the thoracodorsal vessels. Because of a number of difficulties using this recipient site, the authors investigated the anatomy and availability of the internal mammary vessels for free flap breast reconstruction. This article describes the anatomic considerations, surgical technique, clinical experience, advantages, and limitations of using these vessels. In recent years, free autogenous tissue transfer for breast reconstruction has become increasingly common. The free transverse rectus abdominis myocutaneous (TRAM) flap and the more recently described deep inferior epigastric artery (DIEA) perforator flap are currently the methods of choice for postmastectomy breast reconstruction. For patients who cannot have a TRAM flap, free flaps from other donor sites (superior gluteal flap, inferior gluteal flap, Rubens flap, lateral transverse thigh flap) also have become important options.