Use of the pectoralis minor in the creation of a submuscular pocket in breast reconstruction

Abstract

The placement of expanders and implants used in breast reconstruction in a submuscular position has been associated with a significant reduction in the number of complications. To create a submuscular pocket and properly position the prosthesis under the breast mound, the muscular attachments to the anterior chest wall must be surgically released. We have found that by splitting the pectoralis minor along its long axis and elevating the lateral half of this muscle in-continuity with the serratus anterior muscle, the lateral portion of the submuscular pocket can be accurately dissected under direct vision. Incorporation of the lateral half of the pectoralis minor in the muscle closure then allows for a larger pocket to be created giving more versatility in choosing the size of an expander or implant. Clinical experience with this technique has proved it to be a reliable modification of submuscular pocket creation for breast reconstruction.