Internal Thoracic Veins

venae thoracicae internae

The internal thoracic veins are paired veins accompanying the internal thoracic artery on each side of the sternum, draining the anterior thoracic wall, the breast, and the diaphragm. They drain into the brachiocephalic veins superiorly. They are the venous drainage of the breast's medial quadrants via anterior intercostal tributaries and are important in breast cancer lymphatic and hematogenous spread.

Region: Chest

Clinical Relevance

Clinical Notes

The internal thoracic veins are encountered during LIMA harvest for coronary artery bypass grafting. They are divided with the ITA during harvest and individually ligated. The internal mammary vein at the second or third intercostal space is used as a recipient vein for free flap anastomosis in breast reconstruction when performed alongside rib segment removal for arterial access. Breast cancer metastasis spreads through the internal thoracic lymphatic system to the parasternal nodes alongside these veins.

Pathology

Common Injuries & Conditions

Internal Thoracic Vein as Recipient for Breast Reconstruction

The internal thoracic vein at the third intercostal space, exposed alongside the ITA after rib cartilage removal, provides the recipient vein for DIEP flap anastomosis; its diameter (typically 2-3 mm) is well-matched to the deep inferior epigastric vein for end-to-end anastomosis in breast reconstruction.