A New Dissection Sequence, Based on Mapping Perforators of Pectoralis Major

Area of Science:

• Plastic Surgery
• Anatomy

Background:

• Breast augmentation is a common cosmetic procedure with ongoing refinement of surgical techniques.
• Existing pocket selection techniques have seen limited evolution in dissection sequence.
• A need exists for improved methods to create submuscular pockets during breast augmentation.

Purpose of the Study:

• To meticulously study the vascular anatomy of the pectoralis major and breast.
• To correlate anatomical findings with imaging data.
• To develop a systematic dissection sequence for a bloodless submuscular pocket in breast augmentation.

Main Methods:

• Cadaveric dissection of ten fresh-frozen specimens to map vascularity in dual-plane pockets.
• Replication of the dissection sequence in 727 female patients undergoing primary breast augmentation.
• Systematic collection of surgical data, implant details, demographics, and complications.

Main Results:

• Identification of eight perforator vessels and a large retropectoral avascular space in cadaver dissections.
• Correlation of anatomical findings with indocyanine green (ICG) imaging.
• Description of four retropectoral zones based on perforator mapping, leading to a significant reduction in postoperative hematomas.

Conclusions:

• A practical, four-zone retropectoral dissection sequence is presented.
• This technique aims to improve precision, safety, and efficiency in creating bloodless retro-muscular pockets.
• The findings suggest a potential to enhance surgical outcomes in breast augmentation procedures.