Pectoralis Major Fascia Research Articles

Triplane technique for breast reconstruction after breast cancer surgery: A case series report.

Implant-based breast reconstruction is an important method for post-mastectomy breast reconstruction. Currently, the most commonly used technique is the biplane technique. However, the high rate of postoperative complications, the inability of pockets to accommodate larger implants, and the expensive costs of biological mesh make the development of new surgical methods urgent. The triplane technique for breast reconstruction is an ideal candidate method. The main local symptoms were breast lump, abnormal breast skin, nipple discharge, and abnormal nipple or areola in 24 patients. The study included 24 female patients who underwent breast reconstruction using the triplane technique after radical breast cancer surgery. The surgical procedure involved measuring the dimensions of the breast, designing the incision, and creating a pocket for the implant using the triplane technique, which includes the pectoralis major muscle, the pectoralis major fascia continuing to the rectus abdominis fascia, and the latissimus dorsa muscle fascia continuing to the rectus abdominis fascia. Postoperative follow-up included regular assessments of pain and evaluation of breast appearance. No cases of postoperative infection were observed in all patients. During the 1-year follow-up period after surgery, 5 patients (20.8%) who needed radiotherapy after mastectomy for cancer showed slight darkening of skin flap pigment after using the triplane technique implant. No cases of exposure or infection of the expanders were reported, and 1 patient underwent expander replacement with a permanent prosthesis. All patients expressed satisfaction with the reconstructed breast shape. The 10 patients (41.7%) experiencing postoperative swelling and pain. However, the pain gradually subsided during the postoperative recovery period. No cases of local recurrence or distant metastasis of breast cancer were observed during the 1-year-follow-up period. The triplane technique for breast reconstruction after breast cancer surgery provides good implant coverage, reduces the risk of complications, and is cost-effective.

Preservation of the pectoralis major fascia has no impact on the long-term oncologic outcomes of patients with breast cancer treated with conservative mastectomy and immediate breast reconstruction: A propensity score matching analysis

The oncologic safety of preserving the pectoralis major fascia (PMF) in patients with breast cancer remains controversial. In this study, we aimed to determine the impact of preserving the PMF on long-term oncologic outcomes in patients with breast cancer treated with immediate implant-based breast reconstruction (IBBR) following conservative mastectomy. We selected women with early-stage breast cancer who underwent conservative mastectomy and submuscular IBBR in our center during 2014-2019. The propensity score matching method was used to create well-balanced fascia-preserved and fascia-removed groups. Locoregional recurrence-free survival (LRFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method and compared using log-rank tests between the fascia-preserved and fascia-removed groups. After matching, there were 219 patients in each group. The mean follow-up time was 64.8±18.1 months for the fascia-preserved group and 64.9±18.4 months for the fascia-removed group. There were no significant differences between the groups in terms of LRFS (91.3% vs. 93.8%; p=0.818), DMFS (94.0% vs. 92.3%; p=0.056), DFS (89.9% vs. 88.4%; p=0.261), and OS (95.8% vs. 95.4%; p=0.783) rates. In the fascia-preserved group, 61.5% of the locoregional recurrence events occurred within 2 years after surgery. Preservation of the PMF did not significantly impact the long-term oncologic outcomes in patients with breast cancer who underwent conservative mastectomy and IBBR. The PMF might be safely preserved in patients without suspicious tumor invasion into this fascia.

Cosmetic considerations for placement of deep brain stimulation pulse generator: the submammary subfascial approach.

Deep brain stimulation (DBS) is an effective treatment for a number of debilitating neurological diseases. However, the placement of an implantable pulse generator (IPG) can lead to significant cosmetic concerns for some patients. We present a subfascial technique of DBS IPG implantation under the breast using a more concealed scar location. The technique is illustrated in a female patient who favored a more aesthetic placement of the DBS to treat essential tremor. Relevant literature of this approach from both breast augmentation and cardiac pacemaker implantation was reviewed. An excellent cosmetic outcome was demonstrated, and reviewing the literature, implanting under the pectoralis major fascia has the potential benefit of reducing complication rates associated with silicone implant placement in the plastic surgery literature when compared to other planes. The subfascial implantation of IPG was described. This plane, which is used routinely in breast augmentation, has the potential to decrease complication rates compared to placement in the subglandular plane. An inframammary incision provides patients with concerns about the scar and stigmata associated with an infraclavicular location of DBS generator a better cosmetic outcome.

Inferior mammary fold reconstruction in reconstructed breast: a novel technique

Background: In breast reconstructive surgery, the infra-mammary fold (IMF) is an integral component of breast identity. The distortion of the IMF during breast surgery or reconstruction following mastectomy often requires restoration. We have developed a new IMF reconstruction technique using de-epithelialised dermis secured to the periosteum of the rib. This acts as a hammock to support the breast tissue in the new position. This paper presents our nine-year experience of performing this original technique following free tissue transfer or tissue expanders (TEs) to reconstruct the breast post-mastectomy. Methods: Pre-operatively, the new IMF line is marked out while the patient is in a standing position. Two centimeters of the lower border of the reconstructed breast is de-epithelialised. The pectoralis major fascia is accessed through the dermis and the lower third of the flap is raised and folded in upwards. The dermis is then stitched to the periosteum of the rib at the desired higher level using interrupted 2/0 polydioxanone (PDS) sutures; thus, creating the new IMF. Results: A total of 9 patients were included in this report. The average age was 49 years (range, 31–61 years). Two cases had bilateral subcutaneous mastectomy and deep inferior epigastric perforator (DIEP) flap reconstruction. One case had immediate DIEP on one side and delayed DIEP on the other. One case had bilateral delayed DIEP. Two cases had unilateral delayed DIEP reconstruction following oncological mastectomy. Three cases were following TEs in unilateral breast reconstruction one of which had a high IMF that needed lowering. IMF in all cases was recreated using the same technique; each achieving a satisfactory outcome with no complications recorded. Conclusions: This technique provides the reconstructed breast with a well-defined IMF and improves its projection. The results are long-lasting and provide a sharp breast-thoracic angle, which is fundamental in the creation of a natural-looking reconstructed breast.

Improvement of Superomedial Breast Reduction and Mastopexy with a New "Hammock" Flap.

Background:Oncoplastic breast reduction shares similar aims and principles with esthetic surgery. Superomedial breast reduction provides harmony, symmetry, and satisfactory lower pole projection, but long-term outcomes are not consistently good. We describe our experience with a new hammock-shaped flap, which was combined with superomedial pedicle breast reduction to improve long-term outcomes by enhancing pedicle support and preventing ptosis recurrence.Methods:From January 2017 to June 2018, 10 patients underwent unilateral breast reduction (n = 7) or bilateral esthetic reduction (n = 3) by a novel approach combining a superomedial pedicle and a perforator-based inferior advancement flap. The flap is based on the inframammary fold (IMF) and fixed to the pectoralis major fascia and the pedicle like a hammock. Preoperative and postoperative (1, 3, 6, 12, and 18 months) measurements included sternal notch-to-superior areola border length, nipple-to-IMF length, and lower pole convexity. Patients rated their satisfaction with breast shape, size, nipple-areola complex position, and lower pole projection at 12 months using a condensed form of the BREAST-Q questionnaire.Results:Esthetic outcomes at 12 and 18 months were good in all patients. There were no complications. Postoperative measurements were stable throughout follow-up. The BREAST-Q scores indicated that most patients were satisfied or very satisfied with their breast(s).Conclusions:This preliminary series demonstrates that the hammock flap, which is performed with autologous tissue, allows changing IMF position, it is safe, effective, and provides improved pedicle fixation and positioning. This technical refinement seems to afford good long-term outcomes in patients undergoing superomedial pedicle breast reduction and mastopexy.

Use of pectoralis major fascia in dorsal nasal augmentation: case report

Use of pectoralis major fascia in dorsal nasal augmentation: case report

Erector spinae plane (ESP) block for postoperative analgesia in total radical mastectomy

Case report: A 50-year-old female patient with an 8-year history of amass in the right breast which has undergone rapid progressive growth, involving the entire breast, over the past 7 months, diagnosed as a phyllodes tumor. Simple right mastectomy with axillary lymph node dissection and pectoralis major fascia resection were performed under general anesthesia. Ultrasound-guided erector spinae plane block was performed for postoperative analgesia, with excellent response up to 18hours following the procedure, and no need for additional opioids. There were no adverse effects or complications associated with the block. Conclusions: Ultrasound-guided erector spinae block is a fast and safe procedure that may be used as a valuable adjunct to ensure postoperative analgesia in radical mastectomy cases, which pose a challenge in terms of pain control. Moreover, it offers an advantage in terms of reduced opioid requirement in these patients.

Retropectoral Cystic Echinococcosis: A Case Report

Background: Cystic echinococcosis of soft tissue is rare even in endemic areas. Intermuscular and intramuscular cystic echinococcoses have been occasionally reported in the literature. Case Presentation: A 40-year-old male was referred to the surgery clinic of Alzahra Hospital, Isfahan, Iran, with a swelling over the right side of his chest in September 2015. In physical examination, a nontender soft bulging in depth of the right pectoralis major muscle with no skin manifestation was noticeable. The axial and coronal contrast-enhanced CT scan showed a multicystic mass lesion between the right pectoralis major and minor muscles with extension beneath the pectoralis minor muscle. The patient underwent a surgery for resection of the mass. After dissection of the pectoralis major fascia, a large cystic mass was visualized just beneath the muscle with some adhesion to the chest wall. Histopatholgic study of the surgical specimen also revealed cystic echinococcosis. Conclusions: This case reveals that cystic echinococcosis should be considered in differential diagnoses of any chest wall swelling.

Radiation-induced low-grade fibromyxoid sarcoma of the chest wall nine years subsequent to radiotherapy for breast carcinoma: A case report.

The present study reports a case of low-grade fibromyxoid sarcoma that occurred in a 62-year-old woman 9 years subsequent to whole breast irradiation for a carcinoma of the left breast, and 18 years following chemotherapy and radiotherapy (RT) for non-Hodgkin's lymphoma (NHL; diagnosed at the age of 43). The patient was 53 years of age when a cT2N0M0 stage IIA breast tumor was identified and excised. A 2.5 cm diameter nodule with dimpling in the upper-outer region of the left breast was detected. Pathological examination revealed that the tumor was an invasive ductal carcinoma, of a solid tubular type. The patient was treated with post-surgical whole breast RT. The left breast received 46 Gy in 23 fractions (2 Gy per fraction) for 4 weeks and 3 days, followed by a cone down boost of 14 Gy in 7 fractions (2 Gy per fraction); therefore a total dose of 60 Gy in 30 fractions was administered. In total, 9 years subsequent to RT, the patient observed a small lump in the left chest wall. The patient underwent excision of the tumor and pectoralis major fascia. Microscopically, the tumor consisted of atypical spindle cells with myxoid stroma. Pathologists concluded that the tumor was a low-grade fibromyxoid sarcoma. Since the tumor developed from tissue in a previously irradiated region, it was considered to be RT-induced, and was classified using the radiation-induced sarcoma (RIS) criteria as dictated by Cahan. Although the majority of RIS cases are angiosarcomas, a rare, low-grade fibromyxoid sarcoma was observed in the present study. The present study hypothesizes that there may have been an overlap region between the RT for supraclavicular nodes of NHL and the whole breast RT for primary breast cancer, due to the results of a retrospective dose reconstruction undertaken by the present study. The patient remained clinically stable for 4 years thereafter, until 2008 when the patient experienced a local relapse and underwent surgery. On 19 October 2011, the patient succumbed to RIS. The current study suggests that the RT history of a patient requires consideration due to the possible development of RIS, including the development of a low-grade fibromyxoid sarcoma, which may lead to a poor prognosis.

Clinical efficacy of dual plane breast augmentation using perinipple incision

Objective To study the technology and the result of dual plane breast augmentation using nipple margin vertical incision of areola. Methods Totally 60 cases of augmentation mammaplasty were involved in this study. The nipple margin vertical incision of areola was applied obliquely into the breast through the pectoralis major fascia. The rib starting point of pectoralis major were cut off, medial to the side of the sternum. Under the pectoralis major the cavity was peeled according to the preoperative design range. Based on the different situation of the breast types Ⅰ, Ⅱ, Ⅲ, dual plane breast augmentations were stripped respectively. After implanting the breast prosthesis, the upper part of the prosthesis was under the pectoralis major and the lower part was under the mammary gland. Results The 60 patients were all after childbearing, 20 of whom underwent type 2 dual plane breast augmentation, 4 underwent type 3 double plane and the rest underwent type 1 double plane. After 3 months to 2 years follow-up, all cases got satisfactory results, except 1 case of postoperative hematoma and 1 case appeared capsular contracture. Conclusions The nipple margin vertical incision of areola can complete types Ⅰ, Ⅱ, Ⅲ dual plane breast augmentation operation, at the same time it can correct mild-to-moderate mastoptosis. Key words: Augmentation mammoplasty; Mammary areola; Perinipple; Incision

Pectoralis major fascia in rhinoplasty.

Fascia is frequently used in rhinoplasty, for several different purposes. The deep temporalis fascia is most often chosen, though harvesting this fascia requires a separate surgical field that adds surgical time to the procedure and morbidity to the patient. In augmentation rhinoplasty cases as well as in many revision rhinoplasty cases, costal cartilage may be required. In these cases, when costal cartilage is harvested from the 5(th) to 7(th) ribs, pectoralis major fascia is in the surgical field and must be incised to provide access to the costal cartilage. Pectoralis major fascia is similar to the deep temporalis fascia, sharing many physical and histological characteristics with it. Pectoralis major fascia can be harvested from the same surgical field as costal cartilage and used in the nose whenever autologous costal cartilage is harvested, thus precluding the need for a separate surgical field for fascia harvest. The surgical technique for harvesting pectoralis major fascia is demonstrated, and two clinical cases of patients in whom this fascia was harvested and used in the nose are presented. Pectoralis major fascia may be considered an alternative option for use in rhinoplasty cases whenever autologous costal cartilage is used. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Endoscopic single port skin-sparing total mastectomy with periareolar incision: Early results.

77 Background: Early-stage breast cancer, such as DCIS, may force to complete removal of the mammary gland because of its wide spread in the breast. For such cases, skin-sparing mastectomy (SSM) should be recommended. However, the conventional oncoplastic surgery leaves some ugly scars on the breast due to large skin incisions. By applying the endoscopic video-assisted breast surgery (VABS), we can provide more aesthetic surgery with single periareolar port approach, leaving only a small and inconspicuous scar on the breast. Methods: VABS of SSM consists of periareolar skin incision, dissection of whole mammary gland, sentinel node (SN) biopsy, and axillary node (AN) dissection. After SSM, the breast reconstruction was performed by the delayed or simultaneous method. We use the implant for simultaneous reconstruction. SN biopsy was performed endoscopically with only 1 cm incision in the axilla which was marked with 3D-CT lymphography prior to surgery. For SSM, we made a skin incision of 2.5 - 3.5 cm incision at the foot-side edge of the areola, to preserve blood flow around the areola. We cut across the gland near the nipple and quickly checked the transected stump by fast frozen section. Subcutaneous detachment was applied to the entire gland. Back of the gland was peeled just above the pectoralis major muscle fascia. The liberated gland was removed through the port with a plastic bag. Results: We performed VABS on 300 patients since 2001, and SSM on 30 patients. Tumor size is 1.6 cm on average. Age is 57.2 years. 23 nipples were preserved. 17 cases were DCIS. 4 were invasive lobular carcinoma. 9 were invasive ductal carcinoma. 2 cases had SN metastasis. One case had AN metastasis. Between VABS and the conventional surgery, there was no difference in the amount of blood loss and operation time. Postoperative aesthetics was particularly good after simultaneous reconstruction. They had less sensory disturbance and high satisfaction. After 38 months, there have been no distant metastases, no postoperative deaths, and one local recurrence). Conclusions: VABS SSM with periareolar skin incision approach makes better aesthetic results.

Complete tissue expander coverage by musculo-fascial flaps in immediate breast mound reconstruction after mastectomy

Immediate breast reconstruction with tissue expander has become an increasingly popular procedure. Complete coverage of the expander by a musculofascial layer provides an additional well-vascularised layer, reducing the rate of possible complications of skin necrosis, prosthesis displacement, and the late capsular contracture. Complete expander coverage can be achieved by a combination of pectoralis major muscle and adjacent thoracic fascia in selected patients. Seventy-five breast mounds in 59 patients were reconstructed, in the first stage a temporary tissue expander inserted immediately after mastectomy and a musculofascial layer composed of the pectoralis major muscle, the serratus anterior fascia, and the superficial pectoral fascia were created to cover the expander. The first stage was followed months later by implant insertion. Minor and major complications were reported in a period of follow-up ranging from 24–42 months (mean 31 months). Complete musculofascial coverage of the tissue expander was a simple and easy to learn technique providing that the patient has a well-formed and intact superficial pectoral and serratus anterior fascia. From a total of 75 breast mounds reconstructed, major complications rate was 4% (overall rate of 19.8%), including major seroma (n = 4), haematoma (n = 1), partial skin loss (n = 3), wound dehiscence (n = 1), major infection (n = 2), severe capsule contracture (n = 1), and expander displacement (n = 3). The serratus anterior fascia and the superficial pectoral fascia flaps can be effectively used as an autologous tissue layer to cover the lower and the lateral aspect of tissue expanders in immediate breast reconstruction after mastectomy.

Use of the pectoralis major fasciocutaneous flap in the treatment of post sternotomy dehiscence: a new approach

To describe a new surgical technique for the treatment dehiscence after median thoracotomy transsternal using fasciocutaneous flap composed of the pectoralis major fascia. Between January 2009 and December 2010, from 1,573 patients submitted to coronary artery bypass graft, 21 developed wound dehiscence after sternotomy and were treated with bilateral pectoralis major muscle fasciocutaneous flap, including partial portion of the rectus abdominis fascia. Patients were followed for a minimum of 90 days postoperatively. All patients had favorable outcome following 90 days, not having any partial or total dehiscence. There were no cases of postoperative infection. The procedure was rapid and effective. Compared with techniques using muscle, myocutaneous or greater omentum flaps, this surgery was less aggressive and maintained the integrity of tissue region. The authors considered that this technique should be used as the first option, leaving the flaps to more complex cases of relapse.

Anterior Intercostal Artery Perforator Flap Autologous Augmentation in Bariatric Mastopexy

Breast reshaping after massive weight loss represents a challenging procedure because of severe hypoplasia and tissue ptosis. Standard mastopexy techniques are often inadequate to restore a pleasant profile and volume. The authors present their experience with the anterior intercostal artery perforator flap in breast autologous augmentation and remodeling. Fifteen bariatric patients (30 breasts) affected by severe breast ptosis and tissue laxity in the upper abdominal wall underwent superior pedicle mastopexy with anterior intercostal artery perforator flap autologous augmentation. The flap was harvested including soft tissues above and below the inframammary fold, extending cranially 5 to 6 cm above the fold and inferiorly over the costal cage and hypochondrium. The flap was completely islanded on intercostal perforators originating from the fifth to seventh intercostal spaces. It was cranially advanced and sutured to the pectoralis major fascia. The medial and lateral borders were sutured together to shape an "autologous implant." All of the flaps were transferred successfully. The donor site was always closed primarily and upper abdominal laxity corrected. All of the breasts presented soft at palpation, with no clinical signs of flap necrosis early or late postoperatively. At 1-year follow-up, the breasts maintained good shape and projection. The anterior intercostal artery perforator flap proved to be a reliable option in bariatric mastopexy. The technique can be performed easily and allows the harvesting of a large amount of tissue with a wide range of motion, providing adequate breast volume and projection without the need for implant placement.

Running Circular Suture Technique for Reduction Mammaplasty and Mastopexy

Many reports have described various technical aspects of reduction mammaplasty and mastopexy procedures. The authors present their technique, which combines a number of techniques already described in the literature regarding repositioning of the nipple-areola complex, reduction of the diameter of the base of the breast, and long-term retention of mammary cone projection. This study evaluated the results for patients of various ages and phenotypes in terms of scar dimensions, breast positioning, and patient satisfaction in the short, medium, and long terms. Mammaplasty was performed using the inverted T technique. The preoperative skin markings differed from those described in the literature in that they did not use the future position of the nipple-areola complex as the main reference point. A running circular suture was used to fix the breast to the pectoralis major fascia and to reduce the diameter of the base of the breast, resulting in a reduced horizontal scar in the inframammary fold. The skin-marking technique allowed for better postoperative breast symmetry regardless of preoperative variations in shape and volume. The outcomes were considered satisfactory in the majority of cases by both the patient (p=0.78) and the physician (p=0.58). Adequate fullness of the upper pole was maintained in 94.7% of the breasts. The described technique results in a reduced diameter of the base of the breast, repair of ptosis, repositioning of the nipple-areola complex, and long-term upper pole fullness. Complications can occur with any technique, but it is important to choose a technique with good quality outcomes overall. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tendinous muscular insertions onto the deep fascia of the upper limb. First part: anatomical study

We examined 30 upper limbs in order to study the tendinous muscular insertions into the deep fascia and to verify whether they have a specific anatomical arrangement and to measure their resilience to traction. We have found that the fascia receives many tendinous muscular insertions, which are always present and exhibit a constant anatomical structure. In particular, the pectoralis major fascia always continues with the brachial fascia in two distinct ways: the fascia overlying the clavicular part of pectoralis major had an expansion towards the anterior brachial fascia, whereas the fascia covering its costal part extended into the medial brachial fascia and the medial intermuscular septum. The lacertus fibrosus was also composed by two groups of fibres: the main group was oriented downwards and medially, the second group longitudinally. The palmaris longus opened out into a fan-shape in the palm of the hand and sent some tendinous expansions to the flexor retinaculum and fascia overlying the thenar eminence muscles. In the posterior region of the arm, the fascia of the latissimus dorsi sent a fibrous lamina to the triceps brachial fascia. The triceps tendon inserted partially into the antebrachial fascia, while the extensor carpi ulnaris sent a tendinous expansion to the fascia of the hypothenar eminence. It is hypothesized that the tendinous muscular insertions maintain the fascia at a basal tension and create myofascial continuity between the different muscles actuating flexion and extension of the upper limb, stretching the fascia in different ways according to the different motor directions.

Oncological outcome after immediate breast reconstruction for invasive breast cancer: a long-term study

Immediate breast reconstruction (IBR) was implemented in 1990. Patients operated on for invasive breast cancer were assessed for oncological outcome after a minimum of 5-year follow-up. The study had a form of a retrospective analysis of 203 consecutive patients. The indications for IBR were always discussed in multidisciplinary case conferences. The pectoralis major fascia was left in place. The implant technique dominated. The break down by tumor stage was T1 tumors in 122 cases, T2 in 72, and T3 tumors in nine. Preoperative chemotherapy was given to 21 patients for tumors >4 cm. Thirteen patients, or 6.5%, developed a local recurrence and seven are still alive with their reconstructed breast after excisions, chemo- and radiation therapy. Most (11) of the 13 recurrences occurred within 24 months after IBR. The recurrence rate remained low with this surgery plus reconstruction approach and IBR is therefore considered a safe procedure when implemented by a multidisciplinary team. Most recurrences appear within 2 years after reconstruction.

Quick Review: Breast Cancer

The breast is centered over the pectoralis major muscle. Its borders are the clavicle; sternum, 6th and 7th rib inferiorly, and is laterally bounded by the pectoralis and serrratus anterior muscles. The innervation of the breast is derived from the anterior branches of the intercostal nerves 2 through 6 with the nipple receiving its innervation from the 4th intercostal nerve. The major blood supply in order of importance is the internal mammary branches, lateral thoracic, thoracodorsal perforating vessels from the pectoral branch of the throacoacrominal branch of the axillary artery and small intercostals branches. Venous and lymphatic drainage parallel the blood supply. The breast tissue is composed of epidermis, dermis, superficial fascia, glandular breast tissue, deep fascial layer and the pectoralis major fascia and muscle. The glandular tissue consists mainly of epithelium, fibrous stroma, and fat. The breast is organized into roughly 20 lobular units made up of terminal ductals surrounded by fat and fibrous tissues and efferent ductules. These terminal ductals coalesce and drain towards the areola forming a single large duct that contributes to the nipple.

Juvenile secretory carcinoma and juvenile papillomatosis: Diagnosis and treatment

Carcinoma of the breast in the child is a rare pathologic entity, constitutes less than 1% of all breast lesions in this age group. The case of a girl with a left breast mass first noticed at 4.5 years of age is presented. An eccentric subareolar mass was excised at 6 years of age, sparing her breast bud. This biopsy contained juvenile secretory carcinoma, with additional pathologic changes characteristic of juvenile papillomatosis. Both the juvenile papillomatosis component as well as the juvenile secretory carcinoma component were devoid of estrogen and progesterone receptors in contrast to nondiseased breast tissue. The assay for these receptors was performed using a new antireceptor monoclonal antibody technique. Simple mastectomy was performed after completion excision demonstrated tumor at the pectoralis major fascia.