The Effect of Rib-Sparing Internal Mammarian Vascular Approach with in Breast Reconstruction on Postoperative Pain Management

Aim: In autologous breast reconstruction, there is pain in the recipient site due to rib cartilage intervention in the postoperative period. In this study, we aimed to reveal the effect of the rib-sparing internal mammarian vessel approach on postoperative pain in breast reconstruction by comparing it with the noncostal-sparing approach.
Patients and Methods: Between 2018 and 2022 twenty five patients underwent surgery were included in the study. Groups were divided according to internal mammary artery(IMA) exposure techniques. Group 1: Patients who underwent rib-sparing surgery(n=9), Group 2: Patients who underwent rib cartilage resection(n=16). Patient Controlled Analgesia(PCA) pump usage time, morphine dose used, and early and late pain scores were noted in both groups in the postoperative period.
Results: The mean age of the patients was 49.8 years. No complications were encountered in the early and late postoperative period. All flap transfers were successful. Mean PCA duration was 24±1.41 hours in group 1 and 26.31±1.62 hours in group 2. The dose of morphine was 9.67±1 mg in group 1 and 23.93±3.02mg in group 2. The early pain score was 2.89±1.16 in group 1 and 5.18±1.22 in group 2. Late pain scores were 2.11±0.98 in group 1 and 2.75±0.77 in group 2.
There was a statistically significant difference between the morphine dose and early pain scores of the groups (p<0.01). There was no significant difference between the duration of PCA use (p=0.3) and late pain scores (p=0.07) (p>0.05).
Conclusion: In conclusion, we think that costal sparing surgery significantly reduces pain in the early period during recipient site preparation in autologous breast r econstruction.