Selective pectoralis major muscle denervation in breast reconstruction: a technical modification for more effective and cosmetic results.

The use of pectoralis major muscle (PMM) in breast reconstruction has been a mainstay for decades. In recent years, although, a novel approach, the so-called subcutaneous or pre-pectoral breast reconstruction, has been introduced advocating the advantages of sparing the pectoralis muscle. Such advantages include more natural implant ptosis and appearance, significant reduction of capsular contracture and also avoidance of implant animation and animation deformities. These are all drawbacks that the use of muscles in implant coverage inevitably involves overtime. Nonetheless, there are clinical situations which definitely require the use of a muscle coverage either for surgical safety or for a better cosmetic outcome. In such cases a slight and simple modification of the standard technique can be adopted to prevent these drawbacks. While performing the muscular pocket two of the three main nerve trunks of the PMM can be severed, thus leaving innervated only the upper portion of the muscle. The remaining two thirds, basically the part covering a tissue expander (TE) or an implant, will therefore retain a status of a viable soft tissue without any muscular contraction. A significant atrophy will definitely ensue, but a sufficiently vascularized and floppy cushion will cover the prosthetic breast reconstruction device, protecting and masking it.