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Clinical Confirmation of the "1-2-3 Rule": The Location of the Internal Mammary Vessels for Microvascular Breast Reconstruction.
Christina Dami Lee, Isis Scomacao, Fatma Betul Tuncer, Andrea Moreira, Graham Schwarz, Risal Djohan
Cleveland Clinic
2020-02-15
Presenter: Fatma Betul Tuncer
Affidavit:
Fatma Betul Tuncer
Director Name: Graham Schwarz
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction: The internal mammary vessels (IMVs) are the most preferred recipient vessels in breast reconstruction. Despite the consistent anatomy, their precise location had not been well described in the literature. Our recent cadaveric study had identified the "1-2-3 rule" which aids intraoperative dissection of IMVs. We found that IMVs travel 1, 2 and 3 cm (within 5 mm range) medial to the costochondral junction (CCJ) at the superior edge of the second, third and fourth rib, respectively. The purpose of this study is to confirm the identified zone of dissection intraoperatively.
Methods: This is a prospective study of consecutive patients who underwent breast reconstruction with abdominally based flaps at a tertiary institution. The measurements were taken at the superior edge of the pertinent rib from CCJ to the lateral edge of the artery or the vein. The level and length of rib resections were recorded. Additional descriptive data (age, height, previous radiation therapy, etc.) from each patient were also collected.
Results: Fifteen breast measurements were taken. Nine measurements were measured at the third costal level with a mean distance of 2.01 cm (range 1.4-2.7 cm). Six measurements were at the fourth costal level with a mean distance of 2.67 cm (range 1.9-3.4 cm).
Conclusions: This clinical study confirms the safe and reliable zone of dissection identified as the "1-2-3 rule" through cadaveric study for internal mammary vessel exposure in-vivo. This is an important tool in internal mammary vessel dissection for less experienced surgeons.
