Commentary on: An Anatomic Appraisal of Biplanar Muscle-Splitting Breast Augmentation.

Abstract

Thank you very much to the editors for the invitation to comment on the cadaveric study, “An Anatomic Appraisal of Biplanar Muscle-Splitting Breast Augmentation.”1 I commend the authors for going back to the anatomy lab to further elucidate the nuances associated with this relatively new approach to breast augmentation. This laboratory study aims to identify a safe zone for performing the biplanar muscle-splitting (BMS) augmentation mammaplasty. I would like to offer my compliments and complements. First let me compliment the authors on a well-structured study and an honest presentation of the weaknesses of the study and areas for future research. Let me also say that I have no personal experience with the BMS technique. Before delving into the merits of the article, it is instructive to revisit the pectoral nerve anatomy to avoid confusion interpreting the literature and this study. The anatomy of the pectoral nerves is a bit confusing. The classic description has the pectoralis major innervated by two nerves; the lateral pectoral nerve and the medial pectoral nerve.2-7 Some authors describe three separate nerves.8-11 One author describes four different nerves.12 The nomenclature can cause confusion as well, anatomists name the nerves according to their origin from the brachial plexus. Unfortunately the course of the medial pectoral nerve is lateral to the lateral pectoral nerve. A very detailed and wonderfully illustrated study of the pectoral nerves by David et al deserves special attention by any aspiring surgeon of the pectoral region.9 In it, they describe a superior, middle, and inferior branch consistently found during 26 brachial plexus dissections. Most importantly the upper two branches (classically referred to as the …