What exactly does muscle dissection mean?

Question

I am very curious about how the muscle is "dissected"? I watched a u tube video of a doctor cauterizing the muscle of an UTM surgery and it looked like there was so much damage being done to the chest wall. If implants are removed can this muscle ever repair itself to the way it was before surgery? Or does Cauterizing damage the muscle for life? My fear is that when I get implants ( small between 295 and 340cc, I am 5'6 and 130lbs) that the muscle will be permanently damaged.

Martin Jugenburg, MD · Answer

Hello, thank you for your question. Usually for sub muscular placement we make a small opening into the base of the pectoralis major to insert the implant. Yes we dissect under the muscle to separate it and make room for the implant (not tear it up).What you are describing in your question most likely took place in a implant removal NOT and implant insertion.  In the case of an implant removal and a capsulectomy where we attempt to remove the capsule, sometimes some of the muscle is so tightly adhered to the capsule that some of it may also get removed. However even if in this case the remaining preserved muscle heals down and patients are still able to use their pectoralis major and minor normally. The pec minor is not affected in these scenarios. Check out our website for more on capsulectomies.

Daniel Barrett, MD · Answer

Dear ErikaApril08,
in order to place implants under the muscle, your surgeon will need to cut a small part of the muscle from the chest wall. I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Christopher Pannucci, MD, MS · Answer

Hi ErikaApril08,
Yours is a great question. There are many ways to do a breast augmentation, but it seems that the videos you are watching and the plan between you and your surgeon is an under the muscle breast augmentation. 
The pectoralis muscle takes its origin from the sternum as well as the lower ribs. Many surgeons who perform under the muscle augmentation will routinely divide the rib origins of the muscle, allowing it to "window shade" upwards. This means that in most under the muscle augmentations, the muscle covers the top portion of the implant, while the bottom portion is under the breast gland itself. This is important, because the implant will stretch out the lower pole to produce a nice shape.
Specific to your question, the cut muscle no longer has an origin point were fixed point, and as such it will not be able to contribute to the muscle strength.
There are alternate techniques for breast augmentation that can injure the muscle less, but may provide less coverage. For particularly thin women, a split muscle technique divides the muscle along its direction of fibers, but does not divide its origin. As such, this technique provides coverage in the upper inner pole where it is needed, without sacrificing muscle strength. Separate but related, a subfascial technique sits under the covering of the muscle but above the muscle itself, to minimize injury to the muscle. 
Ultimately, it is important for you in your surgeon to be at the same page about what plane your implants will be placed in.
Hope this helps.
Sincerely,Christopher Pannucci MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Connie Hiers, MD, FACS · Answer

Most of the muscle is just lifted up so that the implant can slide in under. However, close to the lowest area near the breast bone, muscle is often released for a short distance and cauterized to minimize bleeding.  Otherwise, there may be an awkward flexing and lifting of the implant when the muscle is used.

What exactly does muscle dissection mean?

Answers (4)

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