To determine if the choice of recipient vessel had any impact on microvascular breast reconstruction, the authors performed a retrospective review of 502 free transverse rectus abdominis myocutaneous (TRAM) breast reconstructions that utilized either the internal mammary vessels (IMV) or thoracodorsal vessels (TDV). All cases were performed at a tertiary care cancer hospital over a 3-year period. Outcomes variables examined were divided into immediate and late complications.

In this series, there were 320 flaps (63.7%) anastomosed to the IMV and 182 (36.3%) anastomosed to the TDV. There was no statistically significant difference between the characteristics/demographics between the two cohorts. We found no statistically significant difference in the aggregate complication rates as well as in the rates of immediate and late flap complications between the two recipient vessel groups. Logistic regression analysis revealed that recipient vessel choice was not associated with any flap complication

Our large series of 502 free TRAM breast reconstructions anastomosed to either the TDV or IMV shows no difference in outcome with respect to vessel choice. The choice of recipient vessels will depend on several factors including ease of dissection, quality of vessels, length of flap pedicle, and of course, the reconstructive plastic surgeon's experience.