Internal Mammary Vessels Lead in Autologous Breast Reconstruction, Review Finds

Key Takeaways

• Internal mammary vessels are now the leading recipient choice in autologous breast reconstruction.
• Vessel selection depends on flap type, prior surgery, and surgeon preference, with thoracodorsal vessels still used in select cases.
• Internal mammary perforators are an emerging option, though concerns about reliability remain.

Autologous breast reconstruction most commonly relies on free tissue transfer to achieve natural-appearing and aesthetically favorable outcomes. In a narrative review published in Gland Surgery, the authors examined recipient vessel selection strategies and their clinical implications in flap-based breast reconstruction.

The authors conducted a PubMed/MEDLINE search from database inception through June 2025 using the terms “recipient vessels,” “breast reconstruction,” “autologous reconstruction,” and “microsurgery.” English-language original investigations and review articles were included, with analysis focused on indications, technical considerations, advantages, and drawbacks of various recipient vessel options.

Multiple factors influence recipient vessel selection, including flap type, mastectomy approach, history of prior breast or axillary surgery, and surgeon preference. According to the review, internal mammary (IM) vessels have emerged as the primary recipient choice, reflecting a broader shift in reconstructive practice patterns. Historically, Thoracodorsal (TD) vessels were more commonly used; however, technical refinements and improved exposure techniques have supported greater adoption of IM vessels.

The authors also discussed IM perforators as an evolving alternative intended to decrease chest wall morbidity. However, they note concerns regarding vessel caliber and reliability. TD and other axillary vessels remain appropriate in selected patients, particularly when IM vessels are unavailable or contraindicated.

“Advancements in reconstructive techniques have changed the landscape for optimal recipient vessel selection from TD vessels to IM vessels,” the authors wrote. “Currently, IMP techniques are the forefront of continued innovation, but alternative recipient vessels may be appropriate in select individuals after considering patient factors and surgeon experience.”