Anatomy of pectoral fascia in relation to subfascial mammary augmentation.

The aim of this study is to elucidate the anatomic details of the pectoral fascia in relation to subfascial breast augmentation.Thirty-two breasts of Korean cadavers were dissected and studied grossly and microscopically. The superficial pectoral fascia (SPF) was easily undermined and separated with an Agris-Dingman dissector. A gentle pushing force by the dissector could stretch the SPF and extend the subfascial pocket further at the lateral border of pectoralis major muscle (PM). The dissector head stayed inside the pocket, not perforating through the fascia. Near the inferior border of PM at the level of the sixth intercostal space, the dissection was hard to advance down beyond rectus abdominis muscle (RA). Yet a continuous vigorous dissection led into the subcutaneous layer of the abdominal wall over RA. The SPF is thick and continues to superficial axillary fascia at the lateral end of the muscle. At the inferior border of the PM (sixth intercostal space), however, the pectoral fascia became thin and feeble. The subfascial implants should be placed under the SPF, laterally beyond the lateral border of PM and inferiorly under the glandular tissue of the breast below the sixth intercostal space.