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Research Article| Volume 65, ISSUE 9, P1193-1198, September 2012

The anatomy of the pectoral nerves and its significance in breast augmentation, axillary dissection and pectoral muscle flaps

Published:April 25, 2012DOI:https://doi.org/10.1016/j.bjps.2012.03.032

      Summary

      Background

      In many plastic surgeries, a detailed understanding of the pectoral nerve anatomy is often required. However, the information available on the anatomy of pectoral nerves is sparse and unclear. The purpose of this study is to provide detailed anatomical information on the pectoral nerves to allow for their easy intra-operative localisation and to improve the understanding of the pectoral muscle innervation.

      Methods

      We dissected 26 brachial plexuses from 15 fresh cadavers. The origins, locations, courses and branches of the pectoral nerves were recorded.

      Results

      We found three constant branches of the pectoral nerve. The superior branch travelled in a straight course to the pectoralis major to innervate the clavicular aspect. The middle branch coursed on the under-surface of the pectoralis major near the pectoral branch of the thoraco-acromial artery to innervate the muscle's sternal aspect. The inferior branch passed beneath the pectoralis minor muscle to innervate the pectoralis minor muscle and the costal aspect of the pectoralis major muscle.

      Conclusions

      Knowing the pectoral nerves' origins, courses and connections, in addition to understanding the functional consequences of iatrogenically severing these nerves, leads to a better understanding of the pectoral muscle's innervation. Precise anatomical data on the pectoral nerve allow for its easy localisation during axillary breast augmentation, axillary dissection, removal of the pectoralis minor muscle and harvesting the pectoralis major muscle island flap.

      Keywords

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      References

        • Corten E.M.
        • Schellekens P.P.
        • Bleys R.L.
        • Kon M.
        The nerve supply to the clavicular part of the pectoralis major muscle: an anatomical study and clinical application of the function-preserving pectoralis major island flap.
        Plast Reconstr Surg. 2003; 112: 969-975
        • Hoffman G.W.
        • Elliott L.F.
        The anatomy of the pectoral nerves and its significance to the general and plastic surgeon.
        Ann Surg. 1987; 205: 504-507
        • Merson M.
        • Pirovano C.
        • Balzarini A.
        • et al.
        The preservation of minor pectoralis muscle in axillary dissection for breast cancer: functional and cosmetic evaluation.
        Eur J Surg Oncol. 1992; 18: 215-218
        • Moosman D.A.
        Anatomy of the pectoral nerves and their preservation in modified mastectomy.
        Am J Surg. 1980; 139: 883-886
        • Scevola S.
        • Cowan J.
        • Harrison D.H.
        Does the removal of pectoralis minor impair the function of pectoralis major?.
        Plast Reconstr Surg. 2003; 112: 1266-1273
        • Tebbetts J.B.
        Axillary endoscopic breast augmentation: processes derived from a 28-year experience to optimize outcomes.
        Plast Reconstr Surg. 2006; 118: 53S-80S
        • Sunderland S.
        Nerves and nerve injuries.
        2nd ed. Churchill Livingstone, Edinburgh; New York1978 (distributed by Longman)
        • Kerr
        The brachial plexus of nerves in man, the variations in its formation and branches.
        Am J Anat. 1918; 23: 285-395
        • Moore K.L.
        • Dalley A.F.
        Clinically oriented anatomy. Lippincott Williams & Wilkins, Philadelphia2006
        • Aszmann O.C.
        • Rab M.
        • Kamolz L.
        • Frey M.
        The anatomy of the pectoral nerves and their significance in brachial plexus reconstruction.
        J Hand Surg Am. 2000; 25: 942-947
      1. David S, Balaguer T, Baque P, Lebreton E. Transfer of pectoral nerves to suprascapular and axillary nerves: an anatomic feasibility study. J Hand Surg Am. 35:92–96.

        • Lee K.S.
        Anatomic variation of the spinal origins of lateral and medial pectoral nerves.
        Clin Anat. 2007; 20: 915-918
        • Chaffai M.A.
        • Mansat M.
        Anatomic basis for the construction of a musculotendinous flap derived from the pectoralis major muscle.
        Surg Radiol Anat. 1988; 10: 273-282
        • Loukas M.
        • Louis Jr., R.G.
        • Fitzsimmons J.
        • Colborn G.
        The surgical anatomy of the ansa pectoralis.
        Clin Anat. 2006; 19: 685-693
      2. Beheiry EE. Innervation of the pectoralis major muscle: anatomical study. Ann Plast Surg.

      3. Niechajev I. Improvements in transaxillary breast augmentation. Aesthetic Plast Surg. 34:322–329.

        • Lopchinsky R.A.
        Locating the axillary vein and preserving the medial pectoral nerve.
        Am J Surg. 2004; 188: 193-194
        • Ung O.
        • Tan M.
        • Chua B.
        • Barraclough B.
        Complete axillary dissection: a technique that still has relevance in contemporary management of breast cancer.
        Anz J Surg. 2006; 76: 518-521
        • Pai A.
        • Gupta P.
        • Raina S.
        • et al.
        Interpectoral approach to dissection of the axillary apex: an elegant and effective approach.
        J Surg Oncol. 2006; 94: 252-254
        • Goncalves Ade V.
        • Teixeira L.C.
        • Torresan R.
        • Alvarenga C.
        • Cabello C.
        Randomized clinical trial on the preservation of the medial pectoral nerve following mastectomy due to breast cancer: impact on upper limb rehabilitation.
        Sao Paulo Med J. 2009; 127: 117-121
        • Scanlon E.F.
        The importance of the anterior thoracic nerves in modified radical mastectomy.
        Surg Gynecol Obstet. 1981; 152: 789-791
        • Reid C.D.
        • Taylor G.I.
        The vascular territory of the acromiothoracic axis.
        Br J Plast Surg. 1984; 37: 194-212
        • Reid C.D.
        • Taylor G.I.
        • Waterhouse N.
        The clavicular head of pectoralis major musculocutaneous free flap.
        Br J Plast Surg. 1986; 39: 57-65
        • Wei W.I.
        • Lam K.H.
        • Wong J.
        The true pectoralis major myocutaneous island flap: an anatomical study.
        Br J Plast Surg. 1984; 37: 568-573
        • Milroy B.C.
        • Korula P.
        Vascularized innervated transfer of the clavicular head of the pectoralis major muscle in established facial paralysis.
        Ann Plast Surg. 1988; 20: 75-81
        • Tobin G.R.
        Pectoralis major segmental anatomy and segmentally split pectoralis major flaps.
        Plast Reconstr Surg. 1985; 75: 814-824
        • Stockinger T.
        • Aszmann O.C.
        • Frey M.
        Clinical application of pectoral nerve transfers in the treatment of traumatic brachial plexus injuries.
        J Hand Surg Am. 2008; 33: 1100-1107
        • Terzis J.K.
        • Kostopoulos V.K.
        The surgical treatment of brachial plexus injuries in adults.
        Plast Reconstr Surg. 2007; 119: 73e-92e

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