Functional and Volumetric Analysis of the Pectoralis Major Muscle After Submuscular Breast Augmentation.
BACKGROUND
Dual plane breast augmentation is a technical variation of the submuscular plane described as a technique that reduces contour deformities due to contraction of the pectoralis major muscle and lower risk of double-bubble deformity associated with breast ptosis. Despite improvement in the aesthetic aspect, there is still no consensus whether this technique affects the function of the pectoralis major muscle.


OBJECTIVE
The aim of this study was to correlate functional with volumetric changes associated with dissection of the muscle origin in submuscular breast augmentation.


METHODS
Thirty women who desired to undergo breast augmentation were selected prospectively and randomly allocated to 2 groups: 10 patients in the control group and 20 patients in the interventional group, who underwent submuscular breast augmentation. Magnetic resonance imaging and volumetric software were used to assess muscle volume and isokinetic dynamometry was used to assess function of the pectoralis major muscle. Preoperative measurements were compared with those at 3, 6, and 12 months after surgery.


RESULTS
Magnetic resonance imaging revealed significant decrease in muscle volume at 6 and 12 months follow-up. The isokinetic test conducted during adduction showed a significant difference in muscle strength between groups from baseline to the 12-month follow-up, and between the 3- and 12-month follow-up. No significant differences in muscle strength during abduction were observed from baseline to the 3-, 6-, and 12-month follow-up.


CONCLUSIONS
Submuscular breast augmentation reduced muscle strength during adduction 12 months after surgery, but without a significant correlation with volumetric muscle loss.


METHODS
Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.
Ana Claudia
AC
Roxo
Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.
Fabio Xerfan
FX
Nahas
Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.
Nadia Cristina
NC
Pinheiro Rodrigues
Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.
José Inácio
JI
Salles
Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.
Victor Rodrigues
VR
Amaral Cossich
Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.
Claudio Cardoso
CC
de Castro
Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.
Jose Horacio
JH
Aboudib
Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.
Ruy Garcia
RG
Marques
D000293:Adolescent; D000328:Adult; D001938:Brazil; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D004210:Dissection / Q000009:adverse effects; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D053580:Muscle Strength; D010369:Pectoralis Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D012984:Software; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult