Montemurro Paolo, Otte Maximilian, Wagner Johannes M, Pafitanis Georgios, Cheema Mubashir, Hedén Per
Akademikliniken, Stockholm, Sweden.
Department of Plastic and Hand Surgery, BG University Hospital Bergmannsheil Bochum, Bochum, Germany.
Plast Reconstr Surg Glob Open. 2023 Jan 18;11(1):e4761. doi: 10.1097/GOX.0000000000004761. eCollection 2023 Jan.
In breast augmentation, during submuscular or dual plane dissection, anatomical variations of the inferior and costal origin of the pectoralis major muscle (PMM) play a key role to ensure optimal implant coverage. Especially, a short and narrow muscle or surgical release along the sternum increases the risk of irregularities and animation deformities of the implant.
In 84 consecutive aesthetic breast augmentations intraoperatively, measurement of PMM dimensions was performed bilaterally. These PMM measurements were then correlated with the preoperative breast width, the inframammary fold, and the placement of the implant's lower pole.
One hundred sixty-eight PMMs of 84 patients were dissected with a dual plane II or III technique for primary aesthetic breast augmentation. In 88% of breasts, the calculated implants' lower pole was below the inferiomedial origin of the pectoralis muscle. In 10% of patients, a separation (more than 1 cm wide and 2 cm wide) in the inferior-medial origin of the PMM was noted. An asymmetry more than 0.5 cm in length between the left and right pectoralis major was noted in 36% of patients.
In this series, the anatomy of the PMM demonstrates a substantial variability in width and length and a considerable asymmetry in its dimensions. These findings emphasize the importance of good access and visualization of the origin of the PMM fibers before its division.
在隆胸手术中，在胸大肌下或双平面剥离过程中，胸大肌（PMM）下部和肋骨起源的解剖变异对于确保最佳的植入物覆盖起着关键作用。特别是，短而窄的肌肉或沿胸骨的手术松解会增加植入物不规则和动态畸形的风险。
在连续84例美容隆胸手术中，术中对双侧胸大肌尺寸进行测量。然后将这些胸大肌测量值与术前乳房宽度、乳房下皱襞以及植入物下极的位置进行关联。
84例患者的168块胸大肌采用双平面II或III技术进行解剖，用于初次美容隆胸。在88%的乳房中，计算得出的植入物下极位于胸大肌下内侧起源下方。在10%的患者中，注意到胸大肌下内侧起源处有分离（宽度超过1厘米且超过2厘米）。在36%的患者中，左右胸大肌之间的长度不对称超过0.5厘米。
在本系列研究中，胸大肌的解剖结构在宽度和长度上表现出很大的变异性，其尺寸存在相当大的不对称性。这些发现强调了在切断胸大肌纤维之前，良好的入路和对其起源的可视化的重要性。
