Role of color duplex sonography in pre-operative internal mammary artery perforators assessment for breast reconstruction using contralateral lower pole flap

Reconstruction of a breast after mastectomy using the contralateral lower pole breast flap is an appealing procedure because it uses the tissues that were going to be excised during reduction of the sound breast to achieve symmetry. The literature mentioned that these flaps are supplied by the lower internal mammary artery perforators (IMAPs) with no further details.The aim of this study was to determine the site, size and number of the 4th and 5th IMAPs by using preoperatively color Duplex ultrasound and to assess its accuracy with intraoperative exploration. Twenty breasts in ten patients who presented for reduction mammoplasty were included in this study. Preoperative color Duplex ultrasound determined IMAPs in the 4th and 5th intercostal spaces. Intraoperative localization of these perforators assured the accuracy of the color Duplex. Statistically, the 4th IMAP diameters were significantly larger than the 5th IMAP diameters (P < 0.05). The study concluded that color Duplex ultrasound is an accurate tool to preoperatively determine the 4th and 5th IMAPs.