Cephalic vein transposition in autologous breast reconstruction salvage: a review of outcomes and implications for patient care

Abstract

Success in microsurgical autologous breast reconstruction is reliant on establishing an effective circulation. Cephalic vein transposition (CVT) is a technique for augmentation, supercharging or replacement of problematic venous anastomoses for free flap salvage. Little is known about the consequences of using this valuable surgical lifeboat for patients. We investigated our experience of CVTs, focusing on the development of lymphedema in the cephalic vein donor limb. A retrospective review was undertaken of consecutive patients undergoing autologous microsurgical breast reconstruction between 2009 and 2015. Patients requiring CVTs were identified and notes reviewed. Outcome measures included further surgery, flap survival, and complications. Between 2009 and 2015, 1208 autologous free tissue transfers for breast reconstruction were performed at our institution. Twelve patients required CVTs for flap salvage. Eleven notes were available for review. Mean age at reconstruction was 51 (43–74). All patients had previous axillary surgery, with post-mastectomy lymphedema noted in four patients. Reconstructions were seven MS-TRAM and four DIEP flaps. Indications for CVT were venous insufficiency in all but one patient, who had scarred internal mammary vessels. No anastomoses required revision and all flaps survived. No wound healing or scar problems were encountered. Lymphedema worsened in two patients and arose de novo in another two patients. The cephalic vein is an excellent local option for free flap salvage in breast reconstruction. Lymphedema, however, developed or worsened in one third of our patients. All patients undergoing microsurgical breast reconstruction are now counseled about the potential need for CVT and the risk of lymphedema. Level of Evidence: Level IV, therapeutic study.