Preserving the internal mammary artery: End-to-side microvascular arterial anastomosis for DIEP and SIEA flap breast reconstruction

BACKGROUND: Microvascular breast reconstruction often sacrifices the internal mammary artery by means of an end-to-end anastomosis. However, an end-to-side anastomosis to the internal mammary artery will maintain the option of using the internal mammary artery for future coronary artery bypass. The authors' goal was to show the feasibility and reliability of the end-to-side arterial anastomosis by comparing it with the end-to-end anastomosis in terms of associated ischemia time, flap weight, incidence of thrombosis and fat necrosis, and overall flap survival. METHODS: The authors reviewed the medical records of 22 consecutive patients who underwent 30 autologous breast reconstructions performed by one surgeon at The Johns Hopkins Hospital Avon Foundation Breast Center and whose deep inferior epigastric artery perforator or superficial inferior epigastric artery flap pedicles were anastomosed using an arterial end-to-side hand-sewn technique (15 anastomoses) or an arterial end-to-end hand-sewn technique (15 anastomoses). The authors compared the identified parameters and set the level of significance at the 0.05 alpha level. RESULTS: The only significant difference between the end-to-side and end-to-end groups was mean ischemia time: 85.3 ± 18.1 minutes (range, 55 to 113 minutes) and 64.4 ± 23.6 minutes (range, 30 to 113 minutes), respectively. CONCLUSIONS: Although ischemia times were increased in the end-to-side group, they remained within acceptable limits. Therefore, this technique is a reliable and technically feasible method of preserving the internal mammary artery system for future potential cardiac surgery.