During breast reconstruction surgery which of the following structure is preserved?
Correct Answer: Pectoralis major
Description: ANSWER: (B) Pectoralis majorREF: Oncoplastic and Reconstructive Surgery for Breast Cancer: By A. Fitoussi, M. G. Berry, B. Couturaud, R. J. Salmon Page 45"As the breast implant is mostly placed beneath the pectoralis major muscle, it is never dissected. A complete musculofascial pocket is created by lateral and inferolateral dissection of the pectoralis minor and serratus anterior. If indicated, mastectomy is performed with preservation of skin envelop, but nipple areola complex is included in the resection with fusiform incision that is more oblique inferiorly"The four surgical approaches to emplacing a breast implant to the implant pocket are described in anatomical relation to the pectoralis major muscle.Subglandular -- the breast implant is emplaced to the retromammary space, between the breast tissue (the gland) and the pectoralis major muscle, which most approximates the plane of normal breast tissue, and affords the most aesthetic results. Yet, in women with thin pectoral soft-tissue, the subglandular position is likelier to show the ripples and wrinkles of the underlying implant. Moreover, the capsular contracture incidence rate is slightly greater with subglandular implantation.Subfascial -- the breast implant is emplaced beneath the fascia of the pectoralis major muscle; this is a variant of the subglandular position. The technical advantages of the subfascial implant-pocket technique are debated; proponent surgeons report that the layer of fascial tissue provides greater implant coverage and better sustains its position.Subpectoral (dual plane) -- the breast implant is emplaced beneath the pectoralis major muscle, after the surgeon releases the inferior muscular attachments, with or without partial dissection of the subglandular plane. Resultantly, the upper pole of the implant is partially beneath the pectoralis major muscle, while the lower pole of the implant is in the subglandular plane.Submuscular -- the breast implant is emplaced beneath the pectoralis major muscle, without releasing the inferior origin of the muscle proper. Total muscular coverage of the implant can be achieved by releasing the lateral muscles of the chest wall -- either the serratus muscle or the pectoralis minor muscle, or both -- and suturing it, or them, to the pectoralis major muscle. In breast reconstruction surgery, the submuscular implantation approach effects maximal coverage of the breast implants.
Category:
Surgery
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