Reuse of the Internal Mammary Vessels as a Recipient Site in Secondary Autologous Breast Reconstruction: A Retrospective Analysis

Background: Secondary breast reconstruction following a failed autologous procedure presents unique challenges, particularly regarding recipient vessel selection. The internal mammary vessels (IMV) are traditionally the preferred recipient site but are often considered unsuitable for secondary reconstruction due to prior anastomosis or ligation during the initial procedure. Alternative flaps with shorter pedicle lengths may lead to complications, such as lateralization of the breast mound when secondary recipient vessels are used. This study evaluates the reuse of the internal mammary system as recipient vessels in salvage breast reconstruction. Methods: A 12-year retrospective review (2012–2024) at a single institution identified patients who underwent secondary autologous breast reconstruction following primary autologous flap failure. All flaps were anastomosed to the IMV during both the primary and salvage reconstructions, with the IMV prepared at a different rib level during the salvage procedure. Patient demographics, perioperative details, and postoperative outcomes were collected and analyzed. Results: Twelve flaps were used to reconstruct ten breasts in nine patients, including one bilateral and eight unilateral reconstructions. The mean age was 56.3 years, mean BMI 27.9, mean flap weight 452.4 grams, and mean operative time 306.1 minutes. The average follow-up period was 243 days. Two cases required reoperation for vascular compromise, both successfully managed. There were no instances of flap loss. Conclusion: The internal mammary vessels can be safely reused in salvage autologous breast reconstruction, even following prior ligation. This approach provides a reliable option for patients facing complex reconstructive scenarios.