title: Anatomy of the sternal origin of the pectoralis major: implications for subpectoral augmentation.
abstract: BACKGROUND
  The pectoralis major typically is manipulated for implant coverage and pocket design in subpectoral breast augmentation. An understanding of its anatomy can guide successful creation of the implant pocket.
  
  
  OBJECTIVE
  The authors evaluated the anatomy of the sternal origin of the pectoralis major to inform surgical planning, help establish a technique for subpectoral augmentation mammaplasty, and identify the most common locations of perforators.
  
  
  METHODS
  The sternal origins of 24 pectoralis major muscles were dissected and examined in 15 female cadavers to determine the structure and width of the pectoralis major sternal origin and its relationship to the locations of internal mammary perforators.
  
  
  RESULTS
  The average width of the sternal origin of the pectoralis major was 7.1 mm (range, 3 mm-1.8 cm). This width decreased slightly from the second rib to the second intercostal space and then increased progressively in the caudal direction toward the fifth rib. The sternal origin terminated an average of 5.4 mm (range, 1-16 mm) from the midline, with the greatest distance at the fifth rib and large variability throughout. A row of perforators from the internal mammary artery traversed the subpectoral space an average of 2.7 cm from the midline (range, 1-3.7 cm).
  
  
  CONCLUSIONS
  The sternal origin of the pectoralis major was thin and highly variable, suggesting that its partial release for implant medialization during subpectoral augmentation is unsafe.
authors.affiliation: Drs Sanchez and Howland are residents, Mr Kaltwasser is a medical student, and Dr Moliver is a Clinical Professor of Plastic Surgery in the Department of Surgery, Division of Plastic Surgery at the University of Texas Medical Branch in Galveston, Texas.
authors.forename: Erick R
authors.initials: ER
authors.lastname: Sanchez
authors.affiliation: Drs Sanchez and Howland are residents, Mr Kaltwasser is a medical student, and Dr Moliver is a Clinical Professor of Plastic Surgery in the Department of Surgery, Division of Plastic Surgery at the University of Texas Medical Branch in Galveston, Texas.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Howland
authors.affiliation: Drs Sanchez and Howland are residents, Mr Kaltwasser is a medical student, and Dr Moliver is a Clinical Professor of Plastic Surgery in the Department of Surgery, Division of Plastic Surgery at the University of Texas Medical Branch in Galveston, Texas.
authors.forename: Kyle
authors.initials: K
authors.lastname: Kaltwasser
authors.affiliation: Drs Sanchez and Howland are residents, Mr Kaltwasser is a medical student, and Dr Moliver is a Clinical Professor of Plastic Surgery in the Department of Surgery, Division of Plastic Surgery at the University of Texas Medical Branch in Galveston, Texas claymoliver@gmail.com.
authors.forename: Clayton L
authors.initials: CL
authors.lastname: Moliver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001837:Body Weights and Measures / Q000379:methods; D019928:Breast Implantation; D002102:Cadaver; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000033:anatomy & histology*; D013249:Sternum / Q000033:anatomy & histology*
keywords: Pectoralis major; sternal origin; subpectoral; subpectoral augmentation