Objective To study the anatomy of internal mammary artery perforator (IMAP) in Chinese patients and the utilization rate of IMAP as recipient vessels for deep inferior epigastric perforator(DIEP) flap breast reconstruction. Methods Ninty-eight consecutive cases with DIEP flap in immediate breast reconstruction from January 2016 to December 2018 were analyzed, 32 cases in IMAP group and 66 cases in internal mammary artery group. All cases had preoperative mapping of perforator with ultrasound. A total of 73 cases had preoperative mapping of perforator with CT angiography (CTA) simultaneously since January 2017. The location and diameter of IMAP were analyzed as well as the utilization rate of IMAP as recipient vessels. Results In 98 cases, IMAP was located in the second intercostal space (ICS) in 66 (67.3%) cases, diameter (1.33±0.66) mm, in the third ICS in 24 (24.5%) cases, diameter (0.86±0.28) mm, and in the fourth ICS in 8 (8.2%) cases, diameter (0.65±0.15) mm. IMAP was used in DIEP flaps in 32 (32.7%) case. A total of 28 (87.5%) perforators were located in the second ICS and 4 (12.5%) perforators in the third ICS. There was no significant difference between IMAP group and internal mammary artery group in patient characteristics and flap complications. The utilization rate of IMAP was 39.7% (29/73) in patients using CTA which was much higher than 12.0% (3/25) in patients without using CTA(P=0.01). Conclusions IMAP as recipient vessel is viable alternative for immediate DIEP flap breast reconstruction when applicable. Preoperative CTA can improve the utilization rate of IMAP. This strategy offers the advantages of decreasing recipient site morbidity, reducing operative time and simplifying procedures.
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