To Resect or Not to Resect: The Effects of Rib-Sparing Harvest of the Internal Mammary Vessels in Microsurgical Breast Reconstruction
Abstract Background The internal mammary vessels are the most commonly used recipients for microsurgical breast reconstructions. Often, the costal cartilage is sacrificed to obtain improved vessel exposure. In an effort to reduce adverse effects associated with traditional rib sacrifice, recent stu...
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| Veröffentlicht in: | Journal of reconstructive microsurgery 2016-02, Vol.32 (2), p.094-100 |
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| creator | Wilson, Stelios Weichman, Katie Broer, P. Niclas Ahn, Christina Y. Allen, Robert J. Saadeh, Pierre B. Karp, Nolan S. Choi, Mihye Levine, Jamie P. Thanik, Vishal D. |
| description | Abstract
Background
The internal mammary vessels are the most commonly used recipients for microsurgical breast reconstructions. Often, the costal cartilage is sacrificed to obtain improved vessel exposure. In an effort to reduce adverse effects associated with traditional rib sacrifice, recent studies have described less-invasive, rib-sparing strategies.
Methods
After obtaining institutional review board's approval, a retrospective review of all patients undergoing microsurgical breast reconstruction at a single institution between November 2007 and December 2013 was conducted. Patients were divided into two cohorts for comparison: rib-sacrificing and rib-sparing internal mammary vessel harvests.
Results
A total of 547 reconstructions (344 patients) met inclusion criteria for this study. A total of 64.9% (
n
= 355) underwent rib-sacrificing internal mammary vessel harvest. Cohorts were similar in baseline patient characteristics, indications for surgery, and cancer therapies. However, patients undergoing rib-sparing reconstructions had significantly shorter operative times (440 vs. 476 minutes;
p
|
| doi_str_mv | 10.1055/s-0035-1558987 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1763702453</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1763702453</sourcerecordid><originalsourceid>FETCH-LOGICAL-c403t-68475f3b5d6d6666c058f4e96e13385d05cbd8ccae135dc5f18b6b1f9286dff93</originalsourceid><addsrcrecordid>eNp1kMFO3DAQhq2qVdlCrz1WPvYSasdx4vQGCAoStNJ2QdwsxxmDURIvHqdSH4D3rqNdeqsvtkff_Jr5CPnE2TFnUn7FgjEhCy6lalXzhqw4a1Wh2qp5S1asqURRq-r-gHxAfGKMVy0v35ODsi4zz9WKvGwCXQOCTTRE-iMkml4L3-jmEei5c_mNNDi69l3xa2uinx7opYm_AdNSTpm6mhLEyQz0xoyjiX_oHSDCgNRP9MbbGHCOD95m4DSCyX1rsGHCFGebfJiOyDtnBoSP-_uQ3F6cb84ui-uf36_OTq4LWzGRllUa6UQn-7qv87FMKldBWwMXQsmeSdv1ylqT_7K30nHV1R13banq3rlWHJIvu9xtDM9znl-PHi0Mg5kgzKh5U4uGlZUUGT3eocvwGMHpbfTLapozvajXqBf1eq8-N3zeZ8_dCP0__NV1BoodkB49jKCfwrwow_8F_gXqsI4N</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1763702453</pqid></control><display><type>article</type><title>To Resect or Not to Resect: The Effects of Rib-Sparing Harvest of the Internal Mammary Vessels in Microsurgical Breast Reconstruction</title><source>MEDLINE</source><source>Thieme Connect Journals</source><creator>Wilson, Stelios ; Weichman, Katie ; Broer, P. Niclas ; Ahn, Christina Y. ; Allen, Robert J. ; Saadeh, Pierre B. ; Karp, Nolan S. ; Choi, Mihye ; Levine, Jamie P. ; Thanik, Vishal D.</creator><creatorcontrib>Wilson, Stelios ; Weichman, Katie ; Broer, P. Niclas ; Ahn, Christina Y. ; Allen, Robert J. ; Saadeh, Pierre B. ; Karp, Nolan S. ; Choi, Mihye ; Levine, Jamie P. ; Thanik, Vishal D.</creatorcontrib><description>Abstract
Background
The internal mammary vessels are the most commonly used recipients for microsurgical breast reconstructions. Often, the costal cartilage is sacrificed to obtain improved vessel exposure. In an effort to reduce adverse effects associated with traditional rib sacrifice, recent studies have described less-invasive, rib-sparing strategies.
Methods
After obtaining institutional review board's approval, a retrospective review of all patients undergoing microsurgical breast reconstruction at a single institution between November 2007 and December 2013 was conducted. Patients were divided into two cohorts for comparison: rib-sacrificing and rib-sparing internal mammary vessel harvests.
Results
A total of 547 reconstructions (344 patients) met inclusion criteria for this study. A total of 64.9% (
n
= 355) underwent rib-sacrificing internal mammary vessel harvest. Cohorts were similar in baseline patient characteristics, indications for surgery, and cancer therapies. However, patients undergoing rib-sparing reconstructions had significantly shorter operative times (440 vs. 476 minutes;
p
< 0.01), and significantly less postoperative pain on postoperative day (POD) 1 (2.8/10 vs. 3.4/10;
p
= 0.033) and POD2 (2.4/10 vs. 3.0/10;
p
= 0.037). Furthermore, patients undergoing rib-sparing techniques had greater incidence of fat necrosis requiring excision (12.5 vs. 2.8%;
p
< 0.01) and a trend toward higher incidence of hematoma, venous thrombosis, and arterial thrombosis when compared with rib-sacrificing patients.
Conclusions
Rib-sparing harvest of internal mammary vessels is a feasible technique in microsurgical breast reconstruction. However, given the significant increase in fat necrosis requiring surgical excision, the trend toward increased postoperative complications, and no significant difference in postoperative revision rates, the purported benefits of this technique may fail to outweigh the possible risks.</description><identifier>ISSN: 0743-684X</identifier><identifier>EISSN: 1098-8947</identifier><identifier>DOI: 10.1055/s-0035-1558987</identifier><identifier>PMID: 26258918</identifier><language>eng</language><publisher>333 Seventh Avenue, New York, NY 10001, USA: Thieme Medical Publishers</publisher><subject>Anastomosis, Surgical - methods ; Breast - blood supply ; Breast - surgery ; Breast Neoplasms - surgery ; Female ; Humans ; Mammaplasty - methods ; Mammary Arteries - transplantation ; Microsurgery - methods ; Middle Aged ; Original Article ; Postoperative Complications ; Retrospective Studies ; Ribs - surgery ; Risk Assessment ; Surgical Flaps ; Treatment Outcome</subject><ispartof>Journal of reconstructive microsurgery, 2016-02, Vol.32 (2), p.094-100</ispartof><rights>Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-68475f3b5d6d6666c058f4e96e13385d05cbd8ccae135dc5f18b6b1f9286dff93</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0035-1558987.pdf$$EPDF$$P50$$Gthieme$$H</linktopdf><linktohtml>$$Uhttps://www.thieme-connect.de/products/ejournals/html/10.1055/s-0035-1558987$$EHTML$$P50$$Gthieme$$H</linktohtml><link.rule.ids>314,776,780,3003,3004,27903,27904,54537,54538</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26258918$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wilson, Stelios</creatorcontrib><creatorcontrib>Weichman, Katie</creatorcontrib><creatorcontrib>Broer, P. Niclas</creatorcontrib><creatorcontrib>Ahn, Christina Y.</creatorcontrib><creatorcontrib>Allen, Robert J.</creatorcontrib><creatorcontrib>Saadeh, Pierre B.</creatorcontrib><creatorcontrib>Karp, Nolan S.</creatorcontrib><creatorcontrib>Choi, Mihye</creatorcontrib><creatorcontrib>Levine, Jamie P.</creatorcontrib><creatorcontrib>Thanik, Vishal D.</creatorcontrib><title>To Resect or Not to Resect: The Effects of Rib-Sparing Harvest of the Internal Mammary Vessels in Microsurgical Breast Reconstruction</title><title>Journal of reconstructive microsurgery</title><addtitle>J reconstr Microsurg</addtitle><description>Abstract
Background
The internal mammary vessels are the most commonly used recipients for microsurgical breast reconstructions. Often, the costal cartilage is sacrificed to obtain improved vessel exposure. In an effort to reduce adverse effects associated with traditional rib sacrifice, recent studies have described less-invasive, rib-sparing strategies.
Methods
After obtaining institutional review board's approval, a retrospective review of all patients undergoing microsurgical breast reconstruction at a single institution between November 2007 and December 2013 was conducted. Patients were divided into two cohorts for comparison: rib-sacrificing and rib-sparing internal mammary vessel harvests.
Results
A total of 547 reconstructions (344 patients) met inclusion criteria for this study. A total of 64.9% (
n
= 355) underwent rib-sacrificing internal mammary vessel harvest. Cohorts were similar in baseline patient characteristics, indications for surgery, and cancer therapies. However, patients undergoing rib-sparing reconstructions had significantly shorter operative times (440 vs. 476 minutes;
p
< 0.01), and significantly less postoperative pain on postoperative day (POD) 1 (2.8/10 vs. 3.4/10;
p
= 0.033) and POD2 (2.4/10 vs. 3.0/10;
p
= 0.037). Furthermore, patients undergoing rib-sparing techniques had greater incidence of fat necrosis requiring excision (12.5 vs. 2.8%;
p
< 0.01) and a trend toward higher incidence of hematoma, venous thrombosis, and arterial thrombosis when compared with rib-sacrificing patients.
Conclusions
Rib-sparing harvest of internal mammary vessels is a feasible technique in microsurgical breast reconstruction. However, given the significant increase in fat necrosis requiring surgical excision, the trend toward increased postoperative complications, and no significant difference in postoperative revision rates, the purported benefits of this technique may fail to outweigh the possible risks.</description><subject>Anastomosis, Surgical - methods</subject><subject>Breast - blood supply</subject><subject>Breast - surgery</subject><subject>Breast Neoplasms - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Mammaplasty - methods</subject><subject>Mammary Arteries - transplantation</subject><subject>Microsurgery - methods</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Postoperative Complications</subject><subject>Retrospective Studies</subject><subject>Ribs - surgery</subject><subject>Risk Assessment</subject><subject>Surgical Flaps</subject><subject>Treatment Outcome</subject><issn>0743-684X</issn><issn>1098-8947</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMFO3DAQhq2qVdlCrz1WPvYSasdx4vQGCAoStNJ2QdwsxxmDURIvHqdSH4D3rqNdeqsvtkff_Jr5CPnE2TFnUn7FgjEhCy6lalXzhqw4a1Wh2qp5S1asqURRq-r-gHxAfGKMVy0v35ODsi4zz9WKvGwCXQOCTTRE-iMkml4L3-jmEei5c_mNNDi69l3xa2uinx7opYm_AdNSTpm6mhLEyQz0xoyjiX_oHSDCgNRP9MbbGHCOD95m4DSCyX1rsGHCFGebfJiOyDtnBoSP-_uQ3F6cb84ui-uf36_OTq4LWzGRllUa6UQn-7qv87FMKldBWwMXQsmeSdv1ylqT_7K30nHV1R13banq3rlWHJIvu9xtDM9znl-PHi0Mg5kgzKh5U4uGlZUUGT3eocvwGMHpbfTLapozvajXqBf1eq8-N3zeZ8_dCP0__NV1BoodkB49jKCfwrwow_8F_gXqsI4N</recordid><startdate>20160201</startdate><enddate>20160201</enddate><creator>Wilson, Stelios</creator><creator>Weichman, Katie</creator><creator>Broer, P. Niclas</creator><creator>Ahn, Christina Y.</creator><creator>Allen, Robert J.</creator><creator>Saadeh, Pierre B.</creator><creator>Karp, Nolan S.</creator><creator>Choi, Mihye</creator><creator>Levine, Jamie P.</creator><creator>Thanik, Vishal D.</creator><general>Thieme Medical Publishers</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160201</creationdate><title>To Resect or Not to Resect: The Effects of Rib-Sparing Harvest of the Internal Mammary Vessels in Microsurgical Breast Reconstruction</title><author>Wilson, Stelios ; Weichman, Katie ; Broer, P. Niclas ; Ahn, Christina Y. ; Allen, Robert J. ; Saadeh, Pierre B. ; Karp, Nolan S. ; Choi, Mihye ; Levine, Jamie P. ; Thanik, Vishal D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-68475f3b5d6d6666c058f4e96e13385d05cbd8ccae135dc5f18b6b1f9286dff93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Anastomosis, Surgical - methods</topic><topic>Breast - blood supply</topic><topic>Breast - surgery</topic><topic>Breast Neoplasms - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Mammaplasty - methods</topic><topic>Mammary Arteries - transplantation</topic><topic>Microsurgery - methods</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Postoperative Complications</topic><topic>Retrospective Studies</topic><topic>Ribs - surgery</topic><topic>Risk Assessment</topic><topic>Surgical Flaps</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wilson, Stelios</creatorcontrib><creatorcontrib>Weichman, Katie</creatorcontrib><creatorcontrib>Broer, P. Niclas</creatorcontrib><creatorcontrib>Ahn, Christina Y.</creatorcontrib><creatorcontrib>Allen, Robert J.</creatorcontrib><creatorcontrib>Saadeh, Pierre B.</creatorcontrib><creatorcontrib>Karp, Nolan S.</creatorcontrib><creatorcontrib>Choi, Mihye</creatorcontrib><creatorcontrib>Levine, Jamie P.</creatorcontrib><creatorcontrib>Thanik, Vishal D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of reconstructive microsurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wilson, Stelios</au><au>Weichman, Katie</au><au>Broer, P. Niclas</au><au>Ahn, Christina Y.</au><au>Allen, Robert J.</au><au>Saadeh, Pierre B.</au><au>Karp, Nolan S.</au><au>Choi, Mihye</au><au>Levine, Jamie P.</au><au>Thanik, Vishal D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>To Resect or Not to Resect: The Effects of Rib-Sparing Harvest of the Internal Mammary Vessels in Microsurgical Breast Reconstruction</atitle><jtitle>Journal of reconstructive microsurgery</jtitle><addtitle>J reconstr Microsurg</addtitle><date>2016-02-01</date><risdate>2016</risdate><volume>32</volume><issue>2</issue><spage>094</spage><epage>100</epage><pages>094-100</pages><issn>0743-684X</issn><eissn>1098-8947</eissn><abstract>Abstract
Background
The internal mammary vessels are the most commonly used recipients for microsurgical breast reconstructions. Often, the costal cartilage is sacrificed to obtain improved vessel exposure. In an effort to reduce adverse effects associated with traditional rib sacrifice, recent studies have described less-invasive, rib-sparing strategies.
Methods
After obtaining institutional review board's approval, a retrospective review of all patients undergoing microsurgical breast reconstruction at a single institution between November 2007 and December 2013 was conducted. Patients were divided into two cohorts for comparison: rib-sacrificing and rib-sparing internal mammary vessel harvests.
Results
A total of 547 reconstructions (344 patients) met inclusion criteria for this study. A total of 64.9% (
n
= 355) underwent rib-sacrificing internal mammary vessel harvest. Cohorts were similar in baseline patient characteristics, indications for surgery, and cancer therapies. However, patients undergoing rib-sparing reconstructions had significantly shorter operative times (440 vs. 476 minutes;
p
< 0.01), and significantly less postoperative pain on postoperative day (POD) 1 (2.8/10 vs. 3.4/10;
p
= 0.033) and POD2 (2.4/10 vs. 3.0/10;
p
= 0.037). Furthermore, patients undergoing rib-sparing techniques had greater incidence of fat necrosis requiring excision (12.5 vs. 2.8%;
p
< 0.01) and a trend toward higher incidence of hematoma, venous thrombosis, and arterial thrombosis when compared with rib-sacrificing patients.
Conclusions
Rib-sparing harvest of internal mammary vessels is a feasible technique in microsurgical breast reconstruction. However, given the significant increase in fat necrosis requiring surgical excision, the trend toward increased postoperative complications, and no significant difference in postoperative revision rates, the purported benefits of this technique may fail to outweigh the possible risks.</abstract><cop>333 Seventh Avenue, New York, NY 10001, USA</cop><pub>Thieme Medical Publishers</pub><pmid>26258918</pmid><doi>10.1055/s-0035-1558987</doi><tpages>7</tpages></addata></record> |
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| ispartof | Journal of reconstructive microsurgery, 2016-02, Vol.32 (2), p.094-100 |
| issn | 0743-684X 1098-8947 |
| language | eng |
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| source | MEDLINE; Thieme Connect Journals |
| subjects | Anastomosis, Surgical - methods Breast - blood supply Breast - surgery Breast Neoplasms - surgery Female Humans Mammaplasty - methods Mammary Arteries - transplantation Microsurgery - methods Middle Aged Original Article Postoperative Complications Retrospective Studies Ribs - surgery Risk Assessment Surgical Flaps Treatment Outcome |
| title | To Resect or Not to Resect: The Effects of Rib-Sparing Harvest of the Internal Mammary Vessels in Microsurgical Breast Reconstruction |
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