Use of Pectoralis Major With or Without Pectoralis Minor Muscle Flap to Fill Lumpectomy in the Breast

Abstract

Treatment of breast cancer has undergone a major change with breast conservation surgery (consisting of lumpectomy and axillary dissection or sentilel lymph node biopsy) and forms a major proportion of the total number of surgeries. To give an aesthetically pleasing breast after surgery has been a challenge and various techniques to fill the breast defect or to reconstruct the partial mastectomy defect are already in practice like local wedge closure, local tissue rearrangement, local advancement flap, thoracodorsal perforator flap, latissmus dorsi flap, silicone implant, reduction mammoplasty, etc. In this article we present the use of pectoralis major muscle with or without pectoralis minor muscle as an innovation, to fill the lumpectomy defects in the upper quadrants of the breast.Ten patients with breast cancer in whom the cancer was between 2 and 4 cm were identified for the study, the prerequisite being that the tumor should be present in the upper quadrants of the breast. Patients with severe ptosis (grade 3) were excluded from the study. After lumpectomy was carried out, using the same incision, pectoralis major muscle flap was harvested based on thoraco-acromian pedicle, rolled over like a ball and used to fill the defect. Pectoralis minor muscle flap was supplemented in 2 patients where additional volume was required. All patients received standard protocol for breast cancer. The postoperative cosmesis was judged by 3 independent judges using visual analogue scale at the end of 9 months.The average tumor size was 2.86 cm. Out of 10 patients in whom it was done, good cosmesis was achieved in 9. The average visual analogue scale score was 87.8. The average operative time was 126 minutes and the hospital stay was 3.5 days. No patient had any flap necrosis. One patient had minor wound infection. None of the patients had positive surgical margin for malignancy.The technique, advantages, limitation, and further scope of this innovation have been dealt in the article. In our opinion this would be a very important armamentarium for the plastic surgeons involved in breast reconstruction.