BACKGROUND The internal mammary artery (IMA) has supplanted the thoracodorsal artery as the primary recipient vessel in autologous breast reconstruction. Additionally, the IMA continues to be the preferred bypass graft choice in patients undergoing coronary artery bypass grafting (CABG). However, practice patterns in breast reconstruction have evolved considerably since the adoption of the IMA for this application. The authors sought to evaluate the safety of IMA harvest for breast reconstruction in our current practice, given the possibility that patients may require CABG in the future. METHODS The authors reviewed the prospective database of free flaps for breast reconstruction performed at their center from 2009 to 2017. Patients were divided into three groups (2009-2011, 2011-2013, 2014-2017) and compared on the basis of demographics, medical comorbidities, and laterality of reconstruction. Patients were further risk stratified for 10-year risk of cardiovascular events using the American College of Cardiology's atheroscletoric and cardiovascular disease (ASCVD) risk calculator. RESULTS There was a marked increase in the number of patients who underwent microsurgical breast reconstruction at our institution over the past three years (2009-2011, n = 55; 2012-2014, n = 50; 2015-2017, n = 145). The distribution of unilateral versus bilateral flaps changed meaningfully; however, they did not change statistically significantly over the study period (2009-2011 = 32.7%, 2012-2014 = 28.0%, 2015-2017 = 49.0%, p = 0.12). The rise in bilateral reconstructions over the study period is commensurate with the observed significant rise in contralateral prophylactic mastectomies (2009-2011 = 25.5%, 2012-2014 = 20.0%, 2015-2017 = 42.1%, p = 0.022). The mean 10-year risk of major cardiovascular events in the entire sample was 6.3 ± 7.1% (median 4.0%). The maximum individual risk score exceeded 25% in all three groups. CONCLUSION Given overall trends in breast reconstruction and the sometimes-elevated cardiac risk profiles of our patients, the authors recommend risk stratification of all patients using the proposed Breast Reconstruction Internal Mammary Assessment (BRIMA) scoring system and consideration of left internal mammary artery preservation in select cases.

中文翻译：

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重新审视内部乳房作为乳房重建中的受体血管：当前实践中的考虑。

背景技术乳内动脉（IMA）已经取代胸背动脉成为自体乳房重建的主要受体血管。此外，IMA 仍然是接受冠状动脉旁路移植术 (CABG) 患者的首选旁路移植术选择。然而，自从采用 IMA 后，乳房再造的实践模式已经有了很大的发展。鉴于患者未来可能需要 CABG，作者试图评估在我们目前的实践中 IMA 收获用于乳房重建的安全性。方法 作者回顾了 2009 年至 2017 年在其中心进行的用于乳房重建的游离皮瓣的前瞻性数据库。将患者分为三组（2009-2011、2011-2013、2014-2017），并根据人口统计数据进行比较，医学合并症和重建的侧向性。使用美国心脏病学会的动脉粥样硬化和心血管疾病 (ASCVD) 风险计算器对患者的 10 年心血管事件风险进行进一步的风险分层。结果在过去三年中，我院接受显微乳房重建术的患者数量显着增加（2009-2011，n = 55；2012-2014，n = 50；2015-2017，n = 145）。单侧与双侧皮瓣的分布发生了有意义的变化；然而，它们在研究期间没有显着变化（2009-2011 = 32.7%，2012-2014 = 28.0%，2015-2017 = 49.0%，p = 0.12）。研究期间双侧重建的增加与观察到的对侧预防性乳房切除术的显着增加相称（2009-2011 = 25.5%，2012-2014 = 20.0%，2015-2017 = 42.1%，p = 0.022）。整个样本中主要心血管事件的平均 10 年风险为 6.3 ± 7.1%（中位数 4.0%）。所有三组的最大个体风险评分均超过 25%。结案例。整个样本中主要心血管事件的平均 10 年风险为 6.3 ± 7.1%（中位数 4.0%）。所有三组的最大个体风险评分均超过 25%。结案例。整个样本中主要心血管事件的平均 10 年风险为 6.3 ± 7.1%（中位数 4.0%）。所有三组的最大个体风险评分均超过 25%。结案例。