Mastopexy following Coronary Artery Bypass Grafting with LIMA Harvest: A Vascular Mapping–Guided Approach to Pedicle Selection

Abstract The internal mammary artery (IMA), particularly the left IMA (LIMA), is frequently utilized in coronary artery bypass grafting (CABG), altering the vascular supply of the ipsilateral breast. This presents a challenge during subsequent breast surgery, with limited literature guiding pedicle selection. We report a 44-year-old woman with a history of CABG using the LIMA, who presented with significant bilateral breast ptosis. Preoperative computed tomography angiography and Doppler ultrasonography were performed to delineate breast perfusion, identify the dominant vascular territories, and guide pedicle selection. Based on these findings, bilateral mastopexy was undertaken, employing a lateral pedicle for the left breast to avoid reliance on the compromised internal mammary perforators and a superomedial pedicle for the right breast. Postoperatively, the nipple–areola complex remained viable, with preserved nipple sensation and satisfactory aesthetic outcomes, without complications. Mastopexy following CABG is feasible with careful preoperative vascular evaluation, and a lateral pedicle provides a safe option in patients with prior LIMA harvest.