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The journal «ONCOSURGERY» 2013, Vol.5, No 1

Enlargement of intermuscular space for one-stage reconstruction after subcutaneous mastectomy (clinicala nd anatomical study)

Troshenkov EA, Pak DD, Usov FN, Petrovsky DA, Kirsanova ON

PA Herzen Moscow Cancer Research Institute, Moscow, Russia
Contact: Troshenkov Evgeniy Alekseevich, e-mail:

Possibilities of creating a combined pocket for silicone endoprothesis, consisting of pectoralis major muscle and compo-site mesh implant is reviewed in the article.

Materials and methods: study was performed on 24 corpses of women who died suddenly. They were divided into

6 groups according to the size of the mammary glands from 0 to 5; 4 corpses with the same size of glands in each group. We measured the thickness, width and length of pectoralis major muscle of female corpses and calculate the volume of pectoralis major muscle in each experiment. The following pattern has been identified: female with normosthenic constitution had volume of MPM from 172.8 to 352 cm3. Hypersthenic women had volume of MPM 353-660 cm3, asthenic – 84-173 cm3.

Results. Two variant of endoprothesis pocket forming were developed. First option without mobilizing ventral part of pectoralis major muscle is to place mesh implant between lateral border of MPM and distal part of dissected anterior serratus muscle. When forming implant pocket using mesh implants according to this method, its volume does not exceed 180 cm3 (which corresponds to the endoprosthesis – no more than size #1). Mobilizing ventral portion of pectoralis major muscle in combination with using mesh implant can increase implant pocket volume up to 335 cm3, which corresponds to the breast size number 3 of bra cups. In the experiment, in 91.7% of cases breast symmetry is achieved: they are the same shape and location of their submammary fold on the same level, in 87.5% nipple-areola complex is symmetric.

Conclusion: for breast #0-1 optimum method for reconstruction is using pectoralis major muscle without its mobilizing and mesh implant, which was established in experiment with expander filling. Mobilizing pectoralis major muscle and fixing mesh implant to it to create additional volume of the endoprosthesis bed effective at 2-3 size of breast bra cups. For the size of breast more than 3 of the bra cups reduction mammoplasty of the contralateral breast is recommended.

KEY WORDS: subcutaneous mammoplasty, mesh implant, primary reconstructive surgery, breast cancer.


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