{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T16:47:18Z","timestamp":1758818838317,"version":"3.28.0"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>\n            Background\u2003Venous congestion in breast free flap reconstruction continues to be a major reason for flap compromise requiring reoperative exploration and possible flap failure. We aim to investigate whether size of the internal mammary vein (IMV) (1) varies between the left and right sides, (2) changes with certain patient demographics or preoperative factors, and (3) correlates with postoperative complications.<\/jats:p><jats:p>\n            Methods\u2003We performed a retrospective cohort study examining all patients undergoing free flap breast reconstruction from September 2005 to March 2016 using internal mammary recipient veins. Venous coupler size was used as a surrogate measure of IMV diameter. Preoperative patient characteristics and factors were collected. Postoperative outcomes assessed included thrombosis, flap loss, fat necrosis, and mastectomy flap necrosis. Multivariate analyses were performed to evaluate if preoperative factors affected IMV diameter and to determine if coupler size and flap side were independent risk factors for postoperative complications.<\/jats:p><jats:p>\n            Results\u2003We examined 372 patients with a total of 561 flaps. One hundred eighty-nine patients received bilateral flaps with the IMV as a recipient. The right IMV (n\u2009=\u2009286, average\u2009=\u20092.97\u2009mm, standard deviation [SD]\u2009=\u20090.41) was significantly larger than the left (n\u2009=\u2009275, average\u2009=\u20092.89, SD\u2009=\u20090.35, p\u2009=\u20090.008). Preoperative factors and postoperative complications were not statistically different between the left and right cohorts. The multivariable linear regression model with coupler size as the dependent variable found older age trended toward a larger coupler size but this was not significant (p\u2009=\u20090.05). In multilinear regression analysis, the postoperative outcomes did not have significant covariates.<\/jats:p><jats:p>\n            Conclusion\u2003We found that IMV size significantly differs between the right and the left sides. However, incidence of postoperative complications was not significantly different between the left and right sides, and the multivariate analyses did not identify flap side as an independent risk factor for adverse outcomes. Prospective studies evaluating actual IMV diameter and associated complications may potentially elucidate clinical significance.<\/jats:p>","DOI":"10.1055\/s-0039-1693157","type":"journal-article","created":{"date-parts":[[2019,7,14]],"date-time":"2019-07-14T22:30:52Z","timestamp":1563143452000},"page":"677-681","source":"Crossref","is-referenced-by-count":9,"title":["Does Size Matter: Evaluating the Difference between Right and Left Internal Mammary Veins in Free Flap Breast Reconstruction"],"prefix":"10.1055","volume":"35","author":[{"given":"Jaclyn T.","family":"Mauch","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania\u2014Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irfan A.","family":"Rhemtulla","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania\u2014Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan B.","family":"Katzel","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania\u2014Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Andres","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania\u2014Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robyn B.","family":"Broach","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania\u2014Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph M.","family":"Serletti","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania\u2014Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2019,7,14]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.jamcollsurg.2014.02.028","article-title":"Propensity-matched, longitudinal outcomes analysis of complications and cost: comparing abdominal free flaps and implant-based breast reconstruction","volume":"219","author":"J P Fischer","year":"2014","journal-title":"J Am Coll Surg"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/PRS.0000000000004519","article-title":"Location of the internal mammary vessels for microvascular autologous breast reconstruction: the \u201c1-2-3 rule\u201d","volume":"142","author":"C D Lee","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1097\/PRS.0b013e31820cf300","article-title":"Feasibility of internal mammary vessel use in breast reconstruction versus coronary artery bypass surgery: an anatomic, cadaveric evaluation","volume":"127","author":"R J Greer-Bayramoglu","year":"2011","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.cps.2012.07.016","article-title":"Advances in autologous breast reconstruction with pedicled perforator flaps","volume":"39","author":"M Hamdi","year":"2012","journal-title":"Clin Plast Surg"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"204e","DOI":"10.1097\/PRS.0000000000002855","article-title":"Evidence-based medicine: autologous breast reconstruction","volume":"139","author":"S A Macadam","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1055\/s-2008-1063936","article-title":"Internal mammary veins: classification and surgical use in free-tissue transfer","volume":"13","author":"A H Schwabegger","year":"1997","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1097\/00006534-199702000-00015","article-title":"Recipient vessels in free-flap breast reconstruction: a study of the internal mammary and thoracodorsal vessels","volume":"99","author":"L J Feng","year":"1997","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s13244-012-0214-8","article-title":"Bilateral analysis of the cross-sectional area of the internal mammary arteries and veins in patients with and without breast cancer on breast magnetic resonance imaging","volume":"4","author":"R J Schipper","year":"2013","journal-title":"Insights Imaging"},{"key":"ref9","first-page":"243","article-title":"Microsurgery in anastomosis of small vessels","volume":"11","author":"J I Jacobson","year":"1960","journal-title":"Surg Forum"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1055\/s-0035-1563737","article-title":"Venous thrombosis in handsewn versus coupled venous anastomoses in 857 consecutive breast free flaps","volume":"32","author":"A R Kulkarni","year":"2016","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1097\/PRS.0b013e3181cb636d","article-title":"1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction","volume":"125","author":"S Jandali","year":"2010","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1055\/s-0037-1606540","article-title":"Economic comparison of hand-sutured and coupler-assisted microvascular anastomoses","volume":"34","author":"L K Head","year":"2018","journal-title":"J Reconstr Microsurg"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1097\/PRS.0000000000003865","article-title":"Smaller diameter anastomotic coupling devices have higher rates of venous thrombosis in microvascular free tissue transfer","volume":"140","author":"S E Hanson","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1002\/micr.22169","article-title":"Venous coupler size in autologous breast reconstruction--does it matter?","volume":"33","author":"P N Broer","year":"2013","journal-title":"Microsurgery"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1097\/PRS.0b013e31829fe321","article-title":"Demystifying the use of internal mammary vessels as recipient vessels in free flap breast reconstruction","volume":"132","author":"E I Chang","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"08","key":"ref16","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1002\/micr.20928","article-title":"Comparison of flow rates in the antegrade and retrograde internal mammary vein for free flap breast reconstruction","volume":"31","author":"M L Venturi","year":"2011","journal-title":"Microsurgery"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0039-1693157.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T11:27:47Z","timestamp":1730806067000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0039-1693157"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,14]]},"references-count":16,"journal-issue":{"issue":"09","published-online":{"date-parts":[[2019,10,15]]},"published-print":{"date-parts":[[2019,11]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0039-1693157","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"type":"print","value":"0743-684X"},{"type":"electronic","value":"1098-8947"}],"subject":[],"published":{"date-parts":[[2019,7,14]]}}}