We read with interest the article by Lin and colleagues entitled “Anatomy and Clinical Significance of Pectoral Fascia” that appeared in the December 2006 issue of the Journal.1 They performed a cadaveric study and the thickness of the pectoral fascia was measured. Their conclusion was that the fascia in the upper quadrants is thicker than that in the lower quadrants. In a previous article, Hwang and Kim2 performed a histologic study and described the pectoral fascia as being akin to a well-developed tissue layer at the upper site; nevertheless, inferiorly, the pectoral fascia became thin. They did not measure the thickness of the fascia.
We performed a study of the thickness of the pectoral fascia in 30 consecutive transaxillary subfascial breast augmentations. Once the subfascial pocket was developed, two samples of pectoral fascia measuring 1 ×1 cm per side were taken with assistance using a lighted retractor. The upper sample was taken at the lateral border of the pectoralis muscle and the lower sample at the level of the areola. The thickness of each sample was measured with an electronic digital micrometer (range, 0 to 25 mm; resolution, 0.001 mm; indication error, 0.004 mm).
The thickness of 120 samples of pectoral fascia from 30 patients was studied. Patient ages ranged between 23 and 41 years (mean age, 33.1 years). The axillary approach was used in 23 patients and the periareolar approach was used in seven patients. The thickness of the pectoral fascia at the upper site varied from 0.106 to 0.229 mm (mean thickness, 0.144 mm) at the upper site and from 0.137 to 0.279 mm (mean thickness, 0.163 mean) at the lower site (Table 1).
The thickness of the fascia in our study was less than that reported by Lin et al.1 This could be explained by differences in the samples and the fact that theirs is a cadaver study.
We have been using subfascial breast augmentation3,4 since its original description by Graf et al.5 Many surgeons still believe that the pectoralis fascia is not an anatomical entity. The aforementioned articles and our measurements show that the pectoralis fascia exists and can be dissected. It does not provide a cover as with the pectoralis muscle, but it provides a good dissection plane to place the implants on the muscle. Our personal experience with subfascial dissection is that it is easier to perform through the transaxillary approach than through the areola. This is supported by the anatomic fact that the fascia is slightly thicker at the upper aspect of the muscle.
J. Benito-Ruiz, M.D., Ph.D.
M. Raigosa, M.D.
M. Manzano, M.D.
L. Salvador, M.D.
Antiaging Group Barcelona, Institut Dexeus, Barcelona, Spain
1. Lin J, Song J, Chen X, et al. Anatomy and clinical significance of pectoral fascia. Plast Reconstr Surg.
2. Hwang K, Kim DJ. Anatomy of pectoral fascia in relation to subfascial mammary augmentation. Ann Plast Surg.
3. Benito-Ruiz J. Subfascial breast implant. Plast Reconstr Surg.
4. Benito-Ruiz J. Transaxillary subfascial breast augmentation. Aesthetic Surg J.
5. Graf RM, Bernardes A, Auersvald A, Damasio RC. Subfascial endoscopic transaxillary augmentation mammaplasty. Aesthetic Plast Surg.
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