A New Dissection Sequence, Based on Mapping Perforators of Pectoralis Major.

Summary

By mapping eight perforators and defining four retropectoral zones, the authors introduce a perforator-guided dissection sequence for dual-plane breast augmentation. Applied to 727 primary cases, the technique correlated with ICG imaging and was associated with fewer postoperative hematomas, supporting safer, more controlled pocket creation.

Key Findings

• Identified eight perforator vessels and a large retropectoral avascular space in cadaveric dissections.
• Defined four retropectoral zones based on perforator mapping, corroborated by ICG imaging.
• Applied the sequence in 727 primary breast augmentations with reduced postoperative hematoma incidence.
• Standardized data collection included implant type (80% textured, 20% smooth) and sizes (150–450 cc).

Clinical Implications

Surgeons can adopt the four-zone, perforator-guided sequence to standardize submuscular pocket dissection, potentially reducing hematomas and improving operative efficiency and outcomes.

Limitations

• Observational design without a randomized control limits causal inference on complication reduction.
• Follow-up duration and long-term outcomes are not detailed; findings may depend on implant type and surgeon experience.

Future Directions

Conduct prospective controlled studies comparing hematoma and revision rates, evaluate learning curves, and assess applicability to revision/secondary augmentation and different implant surfaces.