Lateral pectoralis nerve: the need to preserve it in the modified radical mastectomy

The preservation of the medial pectoralis nerve is classical and compulsory in the Patey Modified Radical Mastectomy, which innervates the clavicular and sternal insertions of the pectoralis major muscle. The lateral pectoralis nerve innervates the lower third, and the costo-abdominal insertions of the pectoralis major muscle. The tight relationship of this nerve with the pectoralis minor muscle makes it impossible to resect the muscle without damaging the nerve. The lesion of this nerve causes fibrosis, atrophy and shortening of the pectoralis major muscle, limitations of the shoulder movements, and a certain degree of skeletonization of the chest wall. Routine removal of the pectoralis minor muscle, as seen in Patey's type operation, with sectioning of the lateral pectoralis nerve, and the above mentioned sequela, is not recommended since it destroys the cosmetic result which is the main objective of the surgery. In naming these structures we prefer Moosman's proposal, because it is easier to remember, it adapts better to our surgical training, and it denotes course location and distribution. We encourage the preservation of the pectoralis minor muscle, and the lateral pectoralis nerve in the modified radical mastectomy, following the Scanlon's proposal in the hope of maintaining a cosmetic aspect and an appropriate base for the reconstructive surgery.