Mammary Reconstruction Using Tissue Expander and Partial Detachment of the Pectoralis Major Muscle to Expand the Lower Breast Quadrants

Serra-Renom, José María; Fontdevila, Joan; Monner, J.; Benito, Juana Gómez

doi:10.1097/01.sap.0000125497.04744.5c

Cited by 34 publications

(17 citation statements)

References 7 publications

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“…Procedures used to improve the soft-tissue dynamic around these devices, including rectus fascial extensions and serratus muscle flaps, can result in an abnormally high riding expander with poor lower pole expansion. 7 Various strategies to improve the drapery of the pectoralis muscle around devices such as marionette sutures, pectoralis muscle rotation flaps, and suturing of the pectoralis to the lower breast flap all have their limitations. 4,7,8 Several authors have documented the benefits of AlloDerm (Life-Cell Corp., Branchburg, N.J.) in the setting of breast reconstruction with tissue expanders.…”

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confidence: 99%

“…7 Various strategies to improve the drapery of the pectoralis muscle around devices such as marionette sutures, pectoralis muscle rotation flaps, and suturing of the pectoralis to the lower breast flap all have their limitations. 4,7,8 Several authors have documented the benefits of AlloDerm (Life-Cell Corp., Branchburg, N.J.) in the setting of breast reconstruction with tissue expanders. 9 -12 This report illustrates the technical aspects of tissue expander reconstruction with acellular dermal matrix and examines the potential advantages it may offer.…”

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confidence: 99%

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Expander/Implant Reconstruction with AlloDerm: Recent Experience

Namnoum

2009

Plastic and Reconstructive Surgery

161

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confidence: 99%

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confidence: 99%

Expander/Implant Reconstruction with AlloDerm: Recent Experience

Namnoum

2009

Plastic and Reconstructive Surgery

161

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“…In a previous paper, we described the importance of detaching the pectoralis major muscle to avoid cranial displacement of the expander and to obtain better expansion of the lower breast quadrants. 5 Furthermore, in an attempt to minimize the possibility of extrusion of the implant, we introduced the use of the endoscopy to detach the muscle. Endoscopy allows making a minimal incision in the most lateral part of the previous mastectomy scar, preserving its integrity.…”

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confidence: 99%

Endoscopic Breast Reconstruction With Intraoperative Complete Tissue Expansion and Partial Detachment of the Pectoralis Muscle

Serra-Renom

Guisantes

Yoon

et al. 2007

Annals of Plastic Surgery

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We present the surgical technique for mammary reconstruction using tissue expander with endoscopic approach, associated to partial detachment of the pectoralis muscle at the fourth rib and complete or nearly complete intraoperative expansion. Tissue expansion for breast reconstruction is a well-honored technique that provides satisfying esthetic outcomes, with minimal morbidity for the patient. Nevertheless, this technique has some potential problems: (1) wound dehiscence with extrusion of the expander; (2) the patient discomfort during the expansion process (weekly visits for the refill of the expander); (3) the poor definition of the lower pole of the breast and cranial migration of the expander with excessive roundness of the upper pole. By using intraoperative tissue expansion, these drawbacks can be avoided. We report herein our experience with this technique in 53 consecutive patients (56 breasts) undergoing a secondary breast reconstruction since December 2001.

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“…16,21,44,45 Surgical trauma to this muscle may include removal of the anterior fascia required for the cancer extirpation, 45 tacking the skin onto the muscle to prevent seroma formation, 2 dissection of the muscle and underlying rib to provide access to blood vessels for vascularizing a surgical flap, 6,29 elevation of the muscle to create a pocket with subsequent expansion to receive a breast implant, 50 or a full release of part of the attachment of the muscle to prevent upward migration of a breast implant and to facilitate expansion of the lower pole of the reconstructed breast. 42 Radiation therapy may also adversely affect the PM muscle.…”

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confidence: 99%

Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery

Stegink-Jansen

Buford²,

Patterson³

et al. 2011

J Orthop Sports Phys Ther

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Early detection and successful cancer treatments have increased the number of long-term breast cancer survivors, 3,5 making optimal recovery and quality of life a primary goal. 8 Up to 50% of survivors have a loss of shoulder motion after completion of their treatments, 28,46 which often extends into a long-term impairment. 33,48 This loss of motion has been found to be predictive of reduced capability to perform functional activities 28 and has been shown to be related to depressive symptoms in a group of 183 older women. 13T T STUDY DESIGN: Descriptive study. T T OBJECTIVES:To quantify and rank the order of strain (length change in proportion to the resting length) of 3 portions of the pectoralis major (PM) muscle during various exercises. T T BACKGROUND:A biomechanical foundation on which to base exercise prescriptions for patients after breast cancer surgery is lacking. T T METHODS: An interactive, 3-D, computergraphic simulation system, developed to study biomechanical properties of the musculoskeletal system, was used to simulate movements of the glenohumeral, scapulothoracic, and scapuloclavicular joints of the shoulder, and to estimate strain in 3 portions of the pectoralis major (PM) muscle throughout the motions. The computed tomography scans of 2 male cadavers and literature review formed the basis for the estimations used in the model. Strains in the clavicular, midsternum, and abdominal regions of the PM were expressed as percent strain: [(change in muscle length/resting length) × 100]. Exercise motions were based on PM muscle anatomy and published breast cancer rehabilitation protocols. T T RESULTS:Strains of the PM regions ranged from -21% shortening of the clavicular region during flexion to 55% lengthening of the abdominal region during the overhead stretch. Strain between adjacent regions was most uniform for the movement of abduction with external rotation, and least uniform with flexion. T T CONCLUSION: PM muscle lengtheningestimates were not linearly proportioned to shoulder joint motions, and varied for 3 portions of the PM. This information may help clinicians and researchers to estimate lengthening of PM portions throughout measurable shoulder motions.

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Mammary Reconstruction Using Tissue Expander and Partial Detachment of the Pectoralis Major Muscle to Expand the Lower Breast Quadrants

Cited by 34 publications

References 7 publications

Expander/Implant Reconstruction with AlloDerm: Recent Experience

Expander/Implant Reconstruction with AlloDerm: Recent Experience

Endoscopic Breast Reconstruction With Intraoperative Complete Tissue Expansion and Partial Detachment of the Pectoralis Muscle

Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery

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