title: What is the Optimal Range of Medial Pocket Dissection in Breast Augmentation? An Anatomical Study of Chinese Women.
abstract: BACKGROUND
  The range of the medial dissection forbidden zone, defined as the no-touch zone in this study, is of great importance in breast augmentation. Currently, 30 mm of the no-touch zone is marked and the pocket dissection does not pass medial to this zone, which lacks anatomical evidence. This study aimed to determine the optimal range of the no-touch zone in breast augmentation by precisely locating relevant anatomical structures.
  
  
  METHODS
  Preoperative multidetector-row CT angiography (MDCTA) was performed in 36 Chinese female patients who were to receive breast reconstruction. The MDCTA data were used to measure the healthy side's horizontal distance from the cutaneous perforators of the internal thoracic artery to the midline, from the sternal origin of the pectoralis major to the midline, from the sternal border to the midline, at the 2nd to 5th intercostal spaces in the subpectoral plane.
  
  
  RESULTS
  All the target tissues were identified in MDCTA data. Mean distances from cutaneous perforators of the internal thoracic artery to the midline of the 2nd to 5th intercostal spaces were 19.66 ± 4.08, 20.37 ± 3.88, 21.00 ± 3.63, and 21.35 ± 4.80 mm; and that from the sternal origin of pectoralis major to midline were 5.00 ± 4.01, 4.83 ± 2.85, 11.67 ± 5.35, and 19.19 ± 7.10 mm; and that from the sternal border to the midline were 12.48 ± 1.70, 14.02 ± 2.05, 13.52 ± 2.91, and 4.68 ± 4.44 mm.
  
  
  CONCLUSIONS
  Most of perforators of the internal thoracic arteries are disrupted in the current surgical process, indicating that the restrictive factor that affects the range of the no-touch zone is the sternal origin of the pectoralis major, rather than the cutaneous perforators. The range of the no-touch zone can be minimized to 20 mm in the 2nd and 3rd intercostal spaces, and can be 30 mm in the 4th intercostal space. However, surgeons should be more cautious to avoid disrupting the origin of the pectoralis major when dissecting the pocket of the 4th and 5th intercostal spaces.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Shangshan
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Chunjun
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Dali
authors.initials: D
authors.lastname: Mu
authors.affiliation: Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Minqiang
authors.initials: M
authors.lastname: Xin
authors.affiliation: Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Su
authors.initials: S
authors.lastname: Fu
authors.affiliation: Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China. doctorluanjie@sina.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Luan
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data; D019928:Breast Implantation / Q000379:methods*; D018427:Breast Implants; D015331:Cohort Studies; D004210:Dissection; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D010369:Pectoralis Muscles / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D013249:Sternum / Q000033:anatomy & histology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Breast augmentation; MDCTA; No-touch zone