Pectoralis major muscle strap in mammoplasty: personal experience

OLIVEIRA JUNIOR, FRANCISCO CLARO DE

FRANCISCO CLARO DE OLIVEIRA JUNIOR^**Corresponding author: Francisco Claro de Oliveira Jr Av. Indianópolis, 2244, São Paulo, SP, Brazil Zip Code 04062-002, E-mail: drfrancisco@franciscoclaro.com

Instituto de Cirurgia Plástica Santa Cruz, São Paulo, SP, Brazil

Universidade Estadual de Campinas, São Paulo, SP, Brazil

Consultório Dr. Francisco Claro Jr., São Paulo, SP, Brazil

*Corresponding author: Francisco Claro de Oliveira Jr Av. Indianópolis, 2244, São Paulo, SP, Brazil Zip Code 04062-002, E-mail: drfrancisco@franciscoclaro.com

Figures (9)
Tables (2)

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Figure 1
Preoperative skin marking.

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Figure 2
A: Left breast: De-epidermized skin around the areola and in the inferior dermoglandular pedicle. The skin areas marked between the deepidermized skin and the ink markings were ultimately removed. Right breast: Final appearance of the inverted "T" scar. B: Lower dermoglandular pedicle under the muscle strap of the pectoralis major muscle.

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Figure 3
Marking of the mediosuperior pedicle, which will be rotated laterally and superiorly and then fixed to point A after de-epidermization of the skin containing the vascular pedicle (left figure, checkered blue area). The entire skin area marked between the de-epidermized skin of the pedicle and the ink marking was ultimately removed.

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Figure 4
Parameters used in Swanson’s photometric evaluation.

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Figure 5
Preand 6-month-postoperative time points showing the efficacy of the muscle strap in increasing upper pole projection and enabling effective breast projection elevation. In this patient, the skin areolate flaps are maintained with a thickness of approximately 1.5 cm. This patient is a representative case of bilateral scar hypertrophy that was due to a possible reaction to the surgical suture that manifested from a 1-month postoperative period (more severe in the right breast).

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Figure 6
Preand 6-month-postoperative time points in an obese patient. In this case, a thicker skin areolate flap (approximately 3 cm) is left despite increased upper pole projection and the greatly increased breast projection elevation provided by the muscle strap. Increased sliding is observed here compared to that in breasts with thinner cutaneous flaps. The patient presented with epitheliosis of the right nipple that resulted in local hypochromia that the patient did not wish to correct or cover with a tattoo.

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Figure 7
Normal distribution between dependent variables analyzed accordingly to the Kolmogorov-Smirnov test, which identified the maintenance of a proper standard in each group and consistency of photometric measurements obtained. A, Percentage of breast projection elevation improvement in the group treated with muscle strap; B, Percentage of breast projection elevation improvement in the group treated without a muscle strap; C, Percentage of breast convexity improvement in the group treated with a muscle strap; D, Percentage of breast convexity improvement in the group treated without a muscle strap; E, Percentage of improvement in the ratio between the upper and lower breast poles in the group treated with a muscle strap. F, Percentage of improvement in the ratio between the upper and lower breast poles in the group treated without a muscle strap.

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Figure 8
Preand 6-month-postoperative time points of a patient treated with a muscle strap with a predominantly fat parenchyma and intense sagging skin as well as a great number of stretch marks. In this patient, skin flaps are left with a thickness of approximately 3 cm. The muscle strap provides good filling of the upper pole and great elevation of the breast projection as assessed by the photometric results.

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Figure 9
Preand 6-month-postoperative time points of a patient who presented with a fat breast that was treated without a muscle strap. On subjective photographic visualization, due to shape improvement, the evolution of the breast could have been considered satisfactory. The patient is quite satisfied with the results; however, the objective photometric analysis method proposed by Swanson22-24 identified it as the worst breast of the study. Careful examination shows that, despite the improved lower pole length obtained by surgery, the evolution is minimal in the projection elevation (MP-pre - MP- post, represented by the yellow arrow) and breast convexity (the upper pole is concave due to the lack of filling), probably due to sliding of the lipoglandular component of the inferior pedicle despite its dermal component remaining fixed to the upper pole.

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Table 1
General breast characteristics in each group.

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Table 2
Averages values obtained in the analysis of the 36 studied breasts

	Mammoplasty with a muscle strap	Mammoplasty without a muscle strap	p
Age (years) Average	29.33	32.37	0.57
Standard deviation	10.95	10.53
Minimum and maximum	17 - 40	18 - 48
Color (%) Caucasian	66.67	66.67	1.00
Non-Caucasian	33.33	33.33
Postoperative time evaluation (months) Average	6.30	6.19
Standard deviation	0.25	0.22	0.18
Minimum and maximum	5.97 - 6.70	5.9 - 6.53
Body mass index (kg/m2) Average	26.73	27.39
Standard deviation	3.70	2.66	0.69
Minimum and maximum	20.76 - 31.37	24.21 - 31.86
Pregnancies completed^* * As the distribution on the Kolmogorov-Smirnov test was non-normal, median and 25% and 75% (Q1/Q3) quartiles were calculated instead of average and standard deviation. The Mann-Whitney U test was used instead of Student’s t test. Median	0.50	1.00
Q1/Q3	0/2	0.50	0.96
Minimum and maximum	0/2	0/2
Smoking status (%) Yes	11.00	0.00	1.00
No	99.00	100.00
Volume removed (g) Average	401.00	555.62
Standard Deviation	160.10	357.92	0.64
Minimum and maximum	130.00 - 742.00	285.00 - 1400.00
Surgical time (minutes) Average	336.88	291.67
Standard deviation	60.12	59.80	0.15
Minimum and Maximum	255-450	240-390

	Mamoplastia com Cinta Muscular		Mamoplastia Sem Cinta Muscular
	Preoperative	Postoperative	Preoperative	Postoperative
UPP (cm) Average	4.85	5.70	5.55	6.50
Standard deviation	1.28	1.56	1.47	1.55
Minimum and maximum	3.39-7.39	3.96-9.00	3.94-8.42	4.49-9.44
BP (cm) Average	10.13	9.36	11.83	11.40
Standard deviation	2.79	2.02	2.89	2.32
Minimum and maximum	7.13-16.15	6.97-13.51	8.63-17.96	8.85-15.06
MP (cm) Average	18.36	12.21	18.30	14.66
Standard deviation	4.62	3.55	3.82	2.48
Minimum and maximum	13.21-27.78	8.75-18.61	12.43-23.71	10.6-167.03
UPA (cm) Average	65.07	69.81	91.60	96.52
Standard deviation	38.78	37.85	38.31	35.05
Minimum and maximum	30.54-146.08	35.27-149.52	47.99-163.59	51.23-167.03
LPA (cm) Average	117.99	39.92	105.61	59.66
Standard deviation	55.07	15.24	53.78	29.22
Minimum and maximum	58.73-234.62	24.4-66.00	40.00-179.48	26.55-112.88
LPL (cm) Average	11.09	4.90	9.17	6.08
Standard deviation	2.79	1.02	2.92	1.89
Minimum and maximum	7.00-15.34	3.51-6.62	5.21-13.78	3.48-8.84
BW (cm) Average	12.11	8.50	12.75	11.36
Standard deviation	1.18	0.74	0.50	0.69
Minimum and maximum	10.72-13.76	7.41-9.45	12.39-13.10	10.87-11.85
Convexity Average	0.48	0.60	0.48	0.57
Standard deviation	0.03	0.04	0.09	0.07
Minimum and maximum	0.46-0.54	0.56-0.67	0.31-0.63	0.45-0.66
PR Average	0.57	1.69	0.99	1.73
Standard deviation	0.23	0.29	0.38	0.34
Minimum and maximum EP (cm) Average	0.33-0.96 6.14	1.35-2.32	0.44-1.56 3.65	0.94-2.18
Standard deviation	1.89		2.39
Minimum and maximum	3.75-9.17		0.62-7.88
%EP^* * p < 0.001. Average difference between groups of 15.32 ± 2.41% (95% confidence interval [CI], 10.41-20.22) according to the Student’s t test.
Average	32.81		17.49
Standard deviation	5.66		8.53
Minimum and maximum	22.21-42.90		4.99-35.18
%Conv
Average	20.18		16.07
Standard deviation	4.46		10.82
Minimum and maximum	12.00-31.31		-6.67-41.56
PR^ p < 0.001. Average difference between groups of 24.20 ± 3.71% (95% CI, 16.65-31.82) according to Student’s t test.
Average	67.65		43.45
Standard deviation	7.66		13.76
Minimum and maximum	50.21-80.36		13.54-69.48

[1] *Corresponding author: Francisco Claro de Oliveira Jr Av. Indianópolis, 2244, São Paulo, SP, Brazil Zip Code 04062-002, E-mail: drfrancisco@franciscoclaro.com

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Pectoralis major muscle strap in mammoplasty: personal experience

ABSTRACT

Introduction:

Method:

Results:

Conclusion: