title: Influence of the Pectoralis Major Muscle Sling in Chest Wall-Based Flap Suspension After Vertical Mammaplasty: Ten-Year Follow-Up.
abstract: BACKGROUND
  The pectoralis muscle sling has proven to be a suitable alternative technique for long-term results in breast parenchyma suspension. Although the pectoralis muscle sling has been subjectively observed to reduce the bottoming-out effect with a bipedicled muscle flap (muscular loop), there has not been a study to objectively or numerically prove it.
  
  
  OBJECTIVE
  This study aimed to radiologically evaluate the influence of a pectoralis muscle sling in supporting the chest wall-based flap after a vertical breast-reduction technique.
  
  
  METHODS
  Twenty-one female patients underwent a vertical breast reduction with the chest wall-based flap and were randomly divided into two subgroups. Ten patients were in subgroup (S), which consisted of patients with a muscle sling. Eleven patients without the muscle sling technique were assigned as a control group (C). Periodic radiological examinations were performed at 1, 3, 6, and 12 months and then at 10 years postoperatively to analyze the breast flap and any migration with respect to three titanium clips placed intraoperatively on the chest wall parenchyma flap.
  
  
  RESULTS
  Patients in subgroup S had a significantly higher difference in migration of the chest wall-based flaps between the first day and 10 years postoperatively when compared with patients in subgroup C (P < .001), as shown by the distances measured between titanium clip locations.
  
  
  CONCLUSIONS
  After 10 years of follow-up, there were changes in chest wall-based flap bottoming-out in patients in whom a pectoralis major muscle sling was utilized compared with those patients without it. Thus, a pectoralis major muscle sling seems to provide greater and longer-lasting support to the flap position on the patient's chest.
  
  
  METHODS
  2 Therapeutic.
authors.affiliation: From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil.
authors.forename: Ruth
authors.initials: R
authors.lastname: Graf
authors.affiliation: From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Ricardo Dall Oglio Tolazzi
authors.affiliation: From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Balbinot
authors.affiliation: From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Pazio
authors.affiliation: From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Miguel Valente
authors.affiliation: From the Division of Plastic and Reconstructive Surgery, Hospital de Clínicas, Federal University of Paraná, and Pietà Medical Center, Curitiba, Paraná, Brazil.
authors.forename: Renato
authors.initials: R
authors.lastname: da Silva Freitas
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D001940:Breast / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000000981:diagnostic imaging / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome