From the Guidelines
During mastectomy reconstruction using the rectus abdominis muscle, the deep inferior epigastric vessels are most likely to be injured. These vessels serve as the primary blood supply to the rectus abdominis muscle flap and must be carefully dissected and preserved during the procedure 1. The deep inferior epigastric artery and vein run along the posterior aspect of the rectus muscle, entering it from below, and are particularly vulnerable during flap harvesting. Injury to these vessels can compromise the viability of the flap and lead to partial or complete flap failure.
Some key points to consider when evaluating the risk of vascular injury during this procedure include:
- The anatomy of the perforators used in DIEP flap is variable, and lack of preoperative imaging can lead to increased operative times 1
- The ideal perforator is the largest caliber and is medially located within the flap with an extended vascular territory beyond the midline to provide optimal perfusion 1
- Dissection of the selected perforator should preserve muscle, and the technical challenge of preserving these vessels is one reason why microsurgical expertise is required for successful TRAM and DIEP flap procedures 1
Additionally, the superficial inferior epigastric vessels may also be at risk, though to a lesser extent. Surgeons must take special care when dissecting around the inferior epigastric system to avoid vascular compromise, which could necessitate additional procedures or result in suboptimal reconstruction outcomes. The use of preoperative imaging can help improve the efficiency of the vascular pedicle selection process and reduce operative times 1.
From the Research
Vessels Affected During Mastectomy Reconstruction
The vessels most likely to be injured during mastectomy reconstruction using the rectus abdominis muscle are:
- Inferior epigastric artery
- Superior epigastric artery
Reasoning
The deep inferior epigastric artery is a significant supplier of blood to the skin of the anterior abdominal wall, including the rectus abdominis muscle 2. During reconstruction, this artery may be at risk of injury. The superior epigastric artery also supplies blood to the rectus abdominis muscle and may be affected during the procedure 2, 3.
Internal Mammary Artery
The internal mammary artery is often used as a recipient vessel in microvascular breast reconstruction 4, 5. However, it is not directly related to the rectus abdominis muscle and is less likely to be injured during the reconstruction procedure using this muscle.
Other Vessels
Other vessels, such as the external iliac artery, are not directly related to the rectus abdominis muscle and are less likely to be injured during the reconstruction procedure using this muscle. The superficial circumflex iliac artery and superficial inferior epigastric artery may be used as alternatives for breast reconstruction, but they are not the primary vessels at risk during rectus abdominis muscle reconstruction 6.