Eck Dustin L, Nguyen David C, Barnes Laura L, Jansen David A
Division of Plastic and Reconstructive Surgery, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL22, RM 8207, New Orleans, LA, 70112, USA.
Aesthetic Plast Surg. 2018 Dec;42(6):1472-1475. doi: 10.1007/s00266-018-1184-0. Epub 2018 Jun 29.
Breast animation deformity is a known complication of subpectoral implant placement that is usually corrected by repositioning the implant to the prepectoral position. Other less common treatment options include performing the muscle splitting biplanar technique, triple plane technique, neuromodulator injections, and secondary neurotomies via transection of the pectoral muscle. We report a patient with animation deformity successfully treated with direct identification and ablation of the medial and lateral pectoral nerves using selective bipolar electrocautery. The patient is a woman with a history of invasive ductal carcinoma who underwent bilateral mastectomy and breast reconstruction with subpectoral implant placement and autologous fat grafting. Within 1 year of her breast reconstruction, she developed hyperactive pectoralis muscle contraction with resulting distortion of both breasts. Given the disadvantages of repositioning the implant to the prepectoral position and transecting the pectoralis muscles via secondary neurotomy, we chose to directly identify and selectively ablate distal branches of the medial and lateral pectoral nerves. This offers a novel technique for correcting breast animation deformity without transecting the pectoralis muscles, causing muscle atrophy, and preserving the subpectoral implant position.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266 .
乳房活动畸形是胸大肌下植入乳房假体已知的一种并发症，通常通过将假体重新放置到胸大肌前位置来矫正。其他不太常见的治疗选择包括采用肌肉劈开双平面技术、三平面技术、神经调节剂注射以及通过切断胸大肌进行二次神经切断术。我们报告了一例通过使用选择性双极电灼直接识别并消融胸内侧神经和胸外侧神经成功治疗活动畸形的病例。该患者为一名有浸润性导管癌病史的女性，她接受了双侧乳房切除术，并采用胸大肌下植入乳房假体和自体脂肪移植进行乳房重建。在乳房重建后1年内，她出现了胸大肌过度收缩，导致双侧乳房变形。鉴于将假体重新放置到胸大肌前位置以及通过二次神经切断术切断胸大肌的缺点，我们选择直接识别并选择性消融胸内侧神经和胸外侧神经的远端分支。这提供了一种无需切断胸大肌、不导致肌肉萎缩且保留胸大肌下假体位置来矫正乳房活动畸形的新技术。证据等级V 本刊要求作者为每篇文章指定证据等级。有关这些循证医学评级的完整描述，请参考目录或作者在线指南www.springer.com/00266 。
