The internal thoracic veins (internal mammary veins) are paired venae comitantes that accompany the internal thoracic artery on the inner surface of the anterior chest wall. They typically drain into the brachiocephalic vein on each side. The veins receive anterior intercostal tributaries and the musculophrenic and superior epigastric veins, mirroring the arterial territory of the ITA.
| Origin | Venae comitantes of the superior epigastric and musculophrenic arteries |
|---|---|
| Course | Ascend beside the internal thoracic artery behind the costal cartilages, usually merging into a single vein in the upper intercostal spaces that drains into the brachiocephalic vein |
| Branches |
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The internal thoracic (internal mammary) vein is the preferred recipient vein for free flap breast reconstruction, exposed at the second or third intercostal space beside the sternum, often after removing a small segment of costal cartilage; its size suits anastomosis to the deep inferior epigastric vein of a DIEP flap. During internal thoracic artery harvest for coronary bypass the accompanying veins are divided and ligated. The parasternal (internal mammary) lymph nodes lie alongside these vessels and receive lymph from the medial breast.
Mediastinal biopsy, parasternal intercostal drain placement, or anterior mediastinoscopy risks injury to the internal thoracic vein, causing venous haemorrhage that is usually controlled with direct pressure or suture ligation but can be profuse given the vein's size.
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