Breast necrosis following coronary arterial bypass grafting in the setting of chest radiation

Coronary artery bypass grafting (CABG) is one of the most commonly performed surgical procedures today, and the internal mammary artery is the conduit of choice. Though grafting of this vessel leads to a substantial decrease of the blood supplied to the breast, ischemic necrosis of the breast remains a rare phenomenon. In the setting of chest radiation, however, subsequent damage to endothelial cells and fibroblasts can threaten the supplemental vasculature. In this report, we share a recent case of CABG-related breast necrosis in the setting of chest radiation, including presentation, diagnosis, and surgical management. We also discuss a comprehensive review of the CABG-related breast necrosis case literature. With increases in CABG procedures and more refined chemoradiation treatment modalities, it is critical that surgeons interacting with these patients be aware of and prepared to address the potentially great impact that chest radiation can have as a probable independent risk factor in the pathophysiologic pathway of ischemic breast necrosis. Level of Evidence: Level V, therapeutic study.