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DOI: 10.5999/aps.2017.00017
Complete coverage of a tissue expander by a musculofascial pocket including the sternalis muscle during breast reconstruction
The sternalis muscle is a vestigial muscle that is vertically long with a rectangular shape, courses parallel or oblique to the long axis of the medial sternocostal part of the pectoralis major, and presents in rare cases (1.3%) [1] [2]. It often has a major effect on the insertion of a tissue expander during breast reconstruction; however, there has only been a single report of the sternalis muscle and the pectoralis major muscle being elevated as a lower mastectomy flap, and no reports have been published about repairing intraoperative trauma [3].
A 66-year-old woman underwent immediate breast reconstruction using a tissue expander after total mastectomy. She had a left-sided sternalis muscle that was 3.5 cm wide and 12.0 cm long ([Figs. 1], [2]). In a musculofascial pocket that included the muscle, a loose adipose connection between the sternalis muscle and the pectoral major muscle collapsed due to the textured surface of the tissue expander to form a caudal lesion that was 5.0 cm long. However, this was successfully repaired using an untied suture technique ([Fig. 3]).
Many plastic surgeons may be unfamiliar with the sternalis muscle; however, they should investigate whether it is present preoperatively via imaging. The merits of the untied suture technique include the certain and safe suturing of both the sternalis muscle, which is often thin, and the pectoralis major muscle without damaging the tissue expander, preventing the recurrence of collapse in this area of connective tissue when inserting it after the ligation of sutures during repair. This technique may be improved by combining it with horizontal mattress sutures.
Publication History
Received: 31 December 2016
Accepted: 02 May 2017
Article published online:
03 April 2022
© 2018. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
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References
- 1 Schulman MR, Chun JK. The conjoined sternalis-pectoralis muscle flap in immediate tissue expander reconstruction after mastectomy. Ann Plast Surg 2005; 55: 672-5
- 2 Barlow RN. The sternalis muscle in American whites and Negroes. Anat Rec 1934; 61: 416-26
- 3 Alani HA, Balalaa N. Complete tissue expander coverage by musculo-fascial flaps in immediate breast mound reconstruction after mastectomy. J Plast Surg Hand Surg 2013; 47: 399-404