Breast Vascular Anatomy and Its Significance in Breast Surgery: An Anatomical Analysis by MRI in Asians.

[BACKGROUND] Most existing research on breast vasculature has focused on autopsy findings or imaging analyses in patients with breast hypertrophy, while investigations specifically targeting augmentation candidates remain limited.

[OBJECTIVE] To delineate the breast arterial anatomy in Asian women with small breasts using magnetic resonance imaging (MRI), thereby providing an anatomical basis for surgical approach selection in clinical practice.

[METHODS] We retrospectively reviewed preoperative contrast-enhanced MRI scans from 47 women scheduled for breast augmentation and postoperative contrast-enhanced MRI scans from 38 women. The study evaluated the location and characteristics of the internal thoracic vein (ITV) and regional arteries and compared the number of identifiable arterial branches across different surgical incision sites.

[RESULTS] As per ITV bifurcation, two anatomical variants were observed. Although 55.3% of type I ITVs were bifurcated, 44.7% of type II ITVs were not bifurcated. The breast received its blood supply from the internal thoracic artery branches (ITA, 100%), axillary artery branches (100%), anterior intercostal artery branches (70.2%), and supra-thoracic artery branches (14.9%). Two blood supply patterns were also observed, in which 83.0% of the breasts had a circular anastomotic pattern dominated by ITA or lateral breast artery, while 17.0% disclosed an unclosed loop pattern directed to the nipple. Moreover, we noticed a significant difference between the number of breast vessels with various incisions (p<0.05).

[CONCLUSION] Breast-enhanced MRI techniques can provide valuable data about the breast region's blood supply. Based on our anatomical analysis, our study suggests that the inframammary approach may be a safer option.

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