At the inferior edge of the pectoralis major muscle, we undermine the superficial pectoralis fascia, in continuity with the pectoralis major muscle itself, up to the inframammary fold (Fig. 1). At this level, the inner side of the superficial pectoralis fascia is cut to release the fascial tension.4,5 In this way, we define the condition for the major expansion in the lower pole.
The superficial pectoralis fascia represents the superficial layer of the pectoralis major muscle fascia, which overlies the pectoralis major muscle and continues inferiorly and laterally to the pectoralis major muscle. At the lateral border of the pectoralis major muscle, the superficial and deep pectoralis fascia fuse themselves and overlie the deeper axillary fascia, creating a unique fascial system that covers the serratus anterior and obliquus externus abdominis muscles. With our technique, no further coverage is needed inferolaterally, as this is anatomically provided by the thoracic fascias.
In skin-expander reconstructions, the skin at the lower pole will expand over time as the implant is filled. In case of skin-preserving mastectomy, when staged skin expansion is unnecessary, the major expansion is immediately gained at the lower pole when the definitive implant is placed.4,5
Using this technique, the expander/implant pocket is anatomically separated by the mastectomy space. In conclusion, the thoracic fascias should be taken into consideration as valuable structures that allow an easy and pleasant breast reconstruction with a low complication rate.5
Marzia Salgarello, M.D.
Giuseppe Visconti, M.D.
Liliana Barone-Adesi, M.D.
University Hospital “A. Gemelli”
The authors have no financial interest to declare in relation to the content of this communication.
1. Losken A, Collins BA, Carlson GW. Dual-plane prosthetic reconstruction using the modified Wise pattern mastectomy and fasciocutaneous flap in women with macromastia. Plast Reconstr Surg
2. Carlson GW, Bostwick J III, Styblo T, et al. Skin sparing mastectomy: Oncologic and reconstructive considerations. Ann Surg.
1997;225:570–575; discussion 575–578.
3. Breuing KH, Warren SH. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg
4. Salgarello M, Visconti G, Barone-Adesi L. Use of the subpectoral fascia flap for expander coverage in postmastectomy breast reconstruction (Letter). Plast Reconstr Surg.
5. Salgarello M, Visconti G, Barone-Adesi L. Nipple-sparing mastectomy with immediate implant reconstruction: Cosmetic outcomes and technical refinements. Plast Reconstr Surg.
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