title: The lateral chest wall:  a separate aesthetic unit in breast surgery.
abstract: BACKGROUND
  The lateral chest wall is an aesthetic unit often overlooked in breast surgery. Abnormalities are often seen in candidates for aesthetic and reconstructive breast surgery and in the massive weight loss population. Preoperative evaluation of the lateral chest wall is necessary to address this area properly. These deformities are intimately associated with the final outcome of any breast operation.
  
  
  METHODS
  To better define deformities of the lateral chest wall, a series of 522 patients who had aesthetic or reconstructive breast surgery was reviewed retrospectively. The preoperative and postoperative photographs were evaluated by two surgeons independently. Any surgical approaches used to correct lateral chest wall deformities were documented.
  
  
  RESULTS
  In evaluating the lateral chest wall, the authors identified three subunit areas that need to be addressed to maximize aesthetic result: the axilla, the lateral breast, and the chest wall. Deficiency and excess of skin and fat contribute to any deformities in this region; deficiency or excess was found in 39 percent of patients. These deformities, when identified, were surgically addressed in 40 percent of patients, as management strategies included transfer of autologous tissue, fat injection, liposuction, or direct excision.
  
  
  CONCLUSIONS
  Lateral chest wall deformities are often found among breast surgery candidates and can affect the final outcome. This area should be treated as a separate aesthetic unit from the breast. Patients with deficiency or excess should be counseled appropriately, as proper treatment may require procedures in addition to the primary breast procedure. The classification system presented can serve as a guideline for management of deformities in this region.
authors.affiliation: Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.
authors.forename: Eran D
authors.initials: ED
authors.lastname: Bar-Meir
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
authors.forename: Adeyiza O
authors.initials: AO
authors.lastname: Momoh
authors.forename: Adam M
authors.initials: AM
authors.lastname: Tobias
authors.forename: Salih
authors.initials: S
authors.lastname: Colakoglu
authors.forename: Janet H
authors.initials: JH
authors.lastname: Yueh
authors.forename: Sumner A
authors.initials: SA
authors.lastname: Slavin
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000601:surgery; D001672:Biocompatible Materials; D018427:Breast Implants; D016009:Chi-Square Distribution; D003094:Collagen; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D035441:Thoracic Wall / Q000601:surgery*; D015625:Tissue Expansion Devices; D055815:Young Adult
chemical_list: C440568:Alloderm; D001672:Biocompatible Materials; D003094:Collagen