Internal mammary vessels as recipients for free TRAM breast reconstruction: aesthetic and functional considerations

The utilisation of the internal mammary vessels (IMVs) as recipient vessels for free TRAM reconstruction of the breast is well established. To gain adequate access to the IMVs, a medial segment of the ipsilateral third costal cartilage is usually excised. Concern has been expressed regarding potential complications specific to use of this site, including pneumothorax, intercostal neuralgia, chest wall herniae and contour defects. We present a retrospective study of our experience with free TRAM breast reconstruction, using the IMVs as recipient vessels, to ascertain the incidence of such complications. Twenty-five consecutive cases were studied. The clinical notes were analysed for information regarding immediate and late complications. All the patients were recalled and underwent assessment and examination by the authors. There were no cases of haemo- or pneumothorax on the side of the reconstruction. There were no complaints of chest pain suggestive of intercostal neuralgia. No discernible contour defects at the site of rib excision were found and no thoracic herniae were demonstrated. We suggest that internal mammary vessels can safely be used as recipients for free TRAM reconstruction of the breasts with no added aesthetic or functional morbidity.