Introduction / Objective: The microanastomosis of a perforator flap pedicle to a perforator recipient vessel in anterior thoracic wall, in order to avoid internal thoracic or thoracodorsal vessel dissection , is feasible in clinical practice. The authors present their preliminary clinical experience with this technique.

Material / Methods : Since June 2001 a search for recipient perforator pedicles in anterior thoracic wall was done in 30 patients who underwent microsurgical breast reconstruction . These vessels are perforators from internal thoracic artery and vein, and its diameter and flow were evaluated, being chosen as recipient pedicles based on authors´ experience. In 22 patients was performed immediate breast reconstruction, being late reconstruction in 8 patients. The average patient age was 52 (+- 3) years. In the late reconstruction group all patients suffered radiotherapy after mastectomy, with a mean interval of 20 months between the surgeries.

Results : In the group who underwent late breast reconstruction were not found perforator vessels clinically adequate as flap recipient. In immediate breast reconstruction group, perforator vessels in the second intercostal space were found in 13 patients. In eight of these patients the vessels had diameter and flow adequate for use as recipient pedicles. Seven DIEP flaps and one SGAP flap were transferred to these perforators into anterior thoracic wall . The flaps coursed without perfusion complications. The 22 patients without recipient perforator pedicles underwent breast reconstruction with DIEP flaps transferred to internal thoracic vessels.

Conclusion: The perforator to perforator breast reconstruction is clinically feasible in selected patients who underwent immediate breast reconstruction. This technique minimizes the morbidity of internal mammary vessels dissection and spares thoracodorsal vessels. The inconstant presence, variable diameter and the extra time spent in delicate dissection of these perforator pedicles are the main disadvantages.