Pectoralis fascia grafts in breast reconstruction

Breast reconstruction plays a vital role in restoring form and self-confidence in patients who have undergone mastectomy for breast cancer. This can be achieved in various ways ranging from simple expander only reconstruction to complex microsurgical free flap reconstructions. Although autologous free tissue transfer is probably the ideal form of breast reconstruction, not all patients are suitable for this and reconstruction needs to individually tailored to the patient. Breast reconstruction with implants and tissue expanders only has been performed with a variety of techniques and in different tissue planes, with advantages and disadvantages apparent in each. The subcutaneous pocket in post-mastectomy patients has been associated with a visible edge to the implant and an apparently higher rate of capsular contracture, whereas the submuscular plane has been thought to cause implant distortion on contraction of the muscle and poor definition of the infra mammary crease. Acellular dermal matrix (ADM) products are being used increasingly in expander reconstruction to cover implants that are only partly covered by the pectoral muscle, to accurately adjust implant position and to define the infra mammary crease. Unfortunately, these engineered tissue products can be expensive. We have used the pectoralis fascia as a graft, in place of an acellular dermal matrix product, to allow complete coverage of an implant in a reconstructed breast. This case is a good example of using autologous pectoral fascia instead of more expensive ADM materials.