Posted by Dr. Hardesty
The purpose of this post is to educate patients in their choice of breast implant position as it relates the pectoralis major music during a breast augmentation.
The pectoralis major muscle is a fan-shaped muscle that partially spans the chest wall. It makes up the bulk of the chest muscles in the male and lies under the breast in the female. Often the pectoral muscle is referred to as “pecs,” the “pectoral muscle” or “chest muscle.”
- On the lateral (or side) groove of the humerus, a long bone in the arm running from shoulder to elbow.
- Deltoid tuberosity — a rough, triangular area on the front surface eof the middle of the humerus, to which the deltoid muscle attaches.
- Clavicular head—anterior (or front) surface of the medial (or middle) half of the clavicle.
- Sternal head— the central breast bone.
The pectoralis major has four actions which are primarily responsible for movement of the shoulder joint.
- The first action is flexion of the humerus, as in throwing a ball side-arm or lifting a child.
- Secondly, it adducts the humerus, as when flapping the arms.
- Thirdly, it rotates the humerus medially, as occurs when arm-wrestling.
- Fourthly, it’s also responsible for keeping the arm attached to the trunk of the body.
A scientific study of strength performance of the pectoralis major muscle after sub-pectoral breast augmentation surgery (performed and authored by S.P. Beals, K.A. Golden and M. Basten — reported in Aesthetic Surgery Journal 2003; 23: 92-97) documented what most plastic surgeons and patients have found. They concluded that sub-pectoral breast implant placement did not produce statistically significant long-term loss of upper-extremity strength performance, and no permanent loss of pectoralis muscle strength resulted from sub-pectoral breast implant placement after breast augmentation.
Using any of the three most-common access incisions (inframammary, periareolar or axillary), the lateral edge of the pectoralis muscle is identified and gently detached (not cut) off the chest wall, leaving both the muscle insertion and origin in tact; this maintains muscle functionality. In reality, it’s nearly impossible to have the pectoralis major muscle completely cover the breast implant. Thus the name/term “dual plane” describes the breast implant is being covered (in the upper portion) with the pectoralis muscle and the lower portion by only breast tissue.
- Less chance for internal scarring (capsular contracture)
- Padding from the muscle, therefore less chance of implant palpability
- Varying degree of animation upon pectoralis major contraction (breasts moving)
- Longer immediate recovery
- In borderline ptosis (breast sag), placement on top of the pectoralis muscle can be an alternative to having a corrective mastopoxy (or breast lift procedure) done.
- Faster immediate recovery
- Increased chance of internal scarring (capsular contracture)
- Increased potential for breast implant palpability (no muscle coverage)
In my practice, based on data and my experience, I personally and almost always place implants under the muscle (dual plane) unless the patient is a professional weightlifter (animation issues).
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