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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 1/2012

01-07-2012 | Preclinical Study

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Authors: Warren M. Rozen, Xuan Ye, Pedro L. Guio-Aguilar, Alberto Alonso-Burgos, John Goldblatt, Mark W. Ashton, Iain S. Whitaker

Published in: Breast Cancer Research and Treatment | Issue 1/2012

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Abstract

Objective To identify possible avenues of sparing the internal mammary artery (IMA) for coronary artery bypass grafting (CABG) in women undergoing autologous breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps. Background Optimal autologous reconstruction of the breast and coronary artery bypass grafting (CABG) are often mutually exclusive as they both require utilisation of the IMA as the preferred arterial conduit. Given the prevalence of both breast cancer and coronary artery disease, this is an important issue for women’s health as women with DIEP flap reconstructions and women at increased risk of developing coronary artery disease are potentially restricted from receiving this reconstructive option should the other condition arise. Methods The largest clinical and cadaveric anatomical study (n = 315) to date was performed, investigating four solutions to this predicament by correlating the precise requirements of breast reconstruction and CABG against the anatomical features of the in situ IMAs. This information was supplemented by a thorough literature review. Results Minimum lengths of the left and right IMA needed for grafting to the left-anterior descending artery are 160.08 and 177.80 mm, respectively. Based on anatomical findings, the suitable options for anastomosis to each intercostals space are offered. In addition, 87–91% of patients have IMA perforator vessels to which DIEP flaps can be anastomosed in the first- and second-intercostal spaces. Conclusion We outline five methods of preserving the IMA for future CABG: (1) lowering the level of DIEP flaps to the fourth- and fifth-intercostals spaces, (2) using the DIEP pedicle as an intermediary for CABG, (3) using IMA perforators to spare the IMA proper, (4) using and end-to-side anastomosis between the DIEP pedicle and IMA and (5) anastomosis of DIEP flaps using retrograde flow from the distal IMA. With careful patient selection, we hypothesize using the IMA for autologous breast reconstruction need not be an absolute contraindication for future CABG.
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Metadata
Title
Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications
Authors
Warren M. Rozen
Xuan Ye
Pedro L. Guio-Aguilar
Alberto Alonso-Burgos
John Goldblatt
Mark W. Ashton
Iain S. Whitaker
Publication date
01-07-2012
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2012
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-011-1948-6

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