The internal mammary (thoracic) perforator arteries are branches of the internal thoracic artery that pierce the anterior intercostal spaces and anterior chest wall to supply the medial breast, pectoral skin, and anterior chest soft tissues. The second intercostal perforator is the dominant medial breast supply in most individuals.
The internal mammary perforators are the basis for the DIEP-equivalent perforator flap from the chest wall and are assessed preoperatively with CTA for breast reconstruction planning. In mastectomy, preserving the internal mammary perforators improves skin flap vascularity. The second intercostal perforator is the most reliable and largest, used as a pedicle for microsurgical chest wall reconstruction. These perforators are divided during internal mammary chain lymph node dissection.
Inadvertent division of internal mammary perforators during mastectomy or sternotomy producing medial skin flap ischaemia and wound breakdown at the medial mastectomy scar.
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