TY - JOUR
T1 - Variance in the origin of the pectoralis major muscle
T2 - Implications for implant-based breast reconstruction
AU - Madsen, Russell J.
AU - Chim, Jimmy
AU - Ang, Brian
AU - Fisher, Orna
AU - Hansen, Juliana
N1 - Publisher Copyright:
Copyright © 2013 by Lippincott Williams & Wilkins.
PY - 2015
Y1 - 2015
N2 - Background: The pectoralis major muscle plays a crucial role in implantbased breast reconstruction. The goal of this study is to document variations of the origin of the pectoralis major muscle (PM). We hope to understand how many women have anatomy allowing for total submuscular coverage of an implant with the PM alone in immediate breast reconstruction. Methods: Fifty patients undergoing mastectomy were recruited. Breast width and the costal origin of the natural inframammary fold (IMF) were measured preoperatively and intraoperatively. The PM width at its origin and the rib origin of the PM were measured intraoperatively. A ratio of the PM origin width to breast width was calculated. Results: Forty-four percent of breasts studied had the IMF at the level of the seventh rib, 53% at the sixth rib, and 3% at the fifth rib. Twenty percent of PM muscles originated from the seventh rib, 68% from the sixth rib, and 12% from the fifth rib. Thirty-six percent of chests showed a PM originating one rib level above the IMF, 61% at the same level, and 3% one level below the IMF. Seventy-seven percent of chests showed a PM origin width to breast width ratio of <0.8. Conclusions: Overall, 72% of chests had either a high origin of the PM, a narrow PM relative to the breast width, or both. This anatomy is suboptimal for implant coverage using the PM alone. Surgeons performing implant-based breast reconstruction should be prepared to utilize wide dissection, alternative muscle recruitment, or supplemental acellular dermal matrix.
AB - Background: The pectoralis major muscle plays a crucial role in implantbased breast reconstruction. The goal of this study is to document variations of the origin of the pectoralis major muscle (PM). We hope to understand how many women have anatomy allowing for total submuscular coverage of an implant with the PM alone in immediate breast reconstruction. Methods: Fifty patients undergoing mastectomy were recruited. Breast width and the costal origin of the natural inframammary fold (IMF) were measured preoperatively and intraoperatively. The PM width at its origin and the rib origin of the PM were measured intraoperatively. A ratio of the PM origin width to breast width was calculated. Results: Forty-four percent of breasts studied had the IMF at the level of the seventh rib, 53% at the sixth rib, and 3% at the fifth rib. Twenty percent of PM muscles originated from the seventh rib, 68% from the sixth rib, and 12% from the fifth rib. Thirty-six percent of chests showed a PM originating one rib level above the IMF, 61% at the same level, and 3% one level below the IMF. Seventy-seven percent of chests showed a PM origin width to breast width ratio of <0.8. Conclusions: Overall, 72% of chests had either a high origin of the PM, a narrow PM relative to the breast width, or both. This anatomy is suboptimal for implant coverage using the PM alone. Surgeons performing implant-based breast reconstruction should be prepared to utilize wide dissection, alternative muscle recruitment, or supplemental acellular dermal matrix.
KW - Acellular dermal matrix
KW - Breast
KW - Immediate breast reconstruction
KW - Inframammary fold
KW - Pectoralis major
KW - Submuscular
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U2 - 10.1097/SAP.0b013e3182858881
DO - 10.1097/SAP.0b013e3182858881
M3 - Article
C2 - 24051466
AN - SCOPUS:84926973801
SN - 0148-7043
VL - 74
SP - 111
EP - 113
JO - Annals of plastic surgery
JF - Annals of plastic surgery
IS - 1
ER -