Letter to the editor: applications of rib sparing technique in internal mammary vessels exposure of abdominal free flap breast reconstructions: a 12-year single-center experience of 215 cases

Stavros Samaras, Yoshie Sasaki, Charles Malata


We read with great interest the article by Zhang and colleagues on the applications of rib sparing technique in internal mammary vessel (IMV) exposure for microvascular breast reconstruction (1). They report a retrospective single institutional study of 215 women who underwent 218 abdominal free flap breast reconstructions, 70 of them using rib-preserving exposure of the IMVs. They compared these with 102 flaps in which the costal cartilage was sacrificed. Their findings that rib sparing IMV exposure is a safe technique with a shorter surgery and hospital stay as well as lower complication rate compared to rib-sacrifice are consistent with our results from a study of the pertinent anatomy of the IMVs during total rib-sparing free flap breast reconstruction (2). Our comments are based on a prospectively collected database of such reconstructions performed by a single surgeon (CMM) using the total rib preservation technique of IMV exposure (3,4).