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Background <p>The internal mammary artery (IMA) is a critical vessel for both autologous breast reconstruction (ABR) and coronary artery bypass grafting (CABG), creating potential conflict when both procedures are needed. This review evaluates evidence on the feasibility, safety, and vascular consequences of using the IMA in ABR while preserving future CABG options.</p> Methods <p>A PRISMA-2020 aligned systematic review assessed IMA use in ABR and implications for future CABG. PubMed, EMBASE, and Web of Science were searched through March 10, 2025, using terms related to ABR and CABG.</p> Results <p>Ten studies (2004–2025) met inclusion criteria, involving female patients aged 24–77 years. Most studies used the deep inferior epigastric perforator flap for ABR, with the IMA as the predominant recipient vessel. Notably, end-to-side arterial anastomosis and dissection at or below the fourth intercostal space were frequently applied to preserve IMA length and integrity for future CABG. Myocardial complication rates after ABR were comparable to flap loss rates, and one patient subsequently underwent CABG using an alternative graft due to prior IMA harvest. Importantly, one cohort study introduced the Breast Reconstruction and Internal Mammary Artery Assessment (BRIMA) score, a cardiovascular risk-stratification tool designed to guide IMA selection in reconstructive planning.</p> Conclusions <p>The IMA may be used in selected ABR cases without significantly limiting future CABG if end-to-side anastomoses or internal mammary artery perforators preserve conduit integrity. Because the IMA is the primary CABG graft, careful surgical planning and cardiovascular risk assessment are crucial. Further prospective data are needed to guide long-term management as the population ages. </p> <p>Level of Evidence: no gradable.</p> Graphical abstract <p></p>

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The internal mammary artery in autologous breast reconstruction and coronary artery bypass grafting

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Mahmut Öztürk,
  • Tobias Niederegger,
  • Thomas Schaschinger,
  • Jule Brandt,
  • Oliver Didzun,
  • Adriana C. Panayi,
  • Valentin Haug,
  • Emre Gazyakan,
  • Amir Bigdeli,
  • Ulrich Kneser,
  • Gabriel Hundeshagen

摘要

Background

The internal mammary artery (IMA) is a critical vessel for both autologous breast reconstruction (ABR) and coronary artery bypass grafting (CABG), creating potential conflict when both procedures are needed. This review evaluates evidence on the feasibility, safety, and vascular consequences of using the IMA in ABR while preserving future CABG options.

Methods

A PRISMA-2020 aligned systematic review assessed IMA use in ABR and implications for future CABG. PubMed, EMBASE, and Web of Science were searched through March 10, 2025, using terms related to ABR and CABG.

Results

Ten studies (2004–2025) met inclusion criteria, involving female patients aged 24–77 years. Most studies used the deep inferior epigastric perforator flap for ABR, with the IMA as the predominant recipient vessel. Notably, end-to-side arterial anastomosis and dissection at or below the fourth intercostal space were frequently applied to preserve IMA length and integrity for future CABG. Myocardial complication rates after ABR were comparable to flap loss rates, and one patient subsequently underwent CABG using an alternative graft due to prior IMA harvest. Importantly, one cohort study introduced the Breast Reconstruction and Internal Mammary Artery Assessment (BRIMA) score, a cardiovascular risk-stratification tool designed to guide IMA selection in reconstructive planning.

Conclusions

The IMA may be used in selected ABR cases without significantly limiting future CABG if end-to-side anastomoses or internal mammary artery perforators preserve conduit integrity. Because the IMA is the primary CABG graft, careful surgical planning and cardiovascular risk assessment are crucial. Further prospective data are needed to guide long-term management as the population ages.

Level of Evidence: no gradable.

Graphical abstract