Lateral Thoracic Vessel as a Recipient Vessel in Immediate Breast Reconstruction after Nipple/Skin-Sparing Mastectomy: Experience with 270 Flaps

Background: The selection of recipient vessels for free-flap breast reconstruction is important for the success of the surgery and the aesthetics of the breast mound. The thoracodorsal artery and vein (TDA/V) allow reconstruction without noticeable scars from the anterior view, but TDA/V exposure is an invasive and time-consuming process on sentinel node biopsy. This study aimed to determine the effectiveness of the lateral thoracic artery and vein (LTA/V) as recipient vessels by comparing them with the TDA/V. Methods: This study included 270 flaps that underwent immediate free-flap breast reconstruction after nipple/skin-sparing mastectomy by lateral incision. The patients were categorized into two groups (LTA and TDA) based on the recipient vessel selected. Results: The LTA and TDA groups comprised 78 and 192 flaps, respectively. Among the 131 short and small pedicle flaps, such as gluteal artery perforator flap and profunda artery perforator flap, 65 (50%) used the LTA as the recipient vessel. The external diameters of the LTA/LTV (median, 1.2 mm/1.5 mm) were significantly lower than those of the TDA/TDV (median, 1.65 mm/2.0 mm). The LTV was present in 94%, and the second vein was present in 49% of cases with anastomosis. No significant differences in flap-related complications were observed between the two groups. Conclusions: The LTA/V can be used as recipient vessels for immediate free-flap reconstruction. Because of their superficial location and small caliber, they are easily accessible and suitable for short and small pedicle flaps. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.