The Pedicled Subpectoral Fascia Flap for Expander Coverage in Postmastectomy Breast Reconstruction: A Novel Technique
Bibliographic record
Abstract
BACKGROUND: In expander-based breast reconstruction, providing adequate tissue coverage of the prosthesis is necessary to prevent complications. The authors have previously described the use of the serratus anterior fascia for this purpose-but when this fascia is unavailable or inadequate, the subpectoral fascia can be used. This study describes the anatomy of the subpectoral fascia, the surgical technique for harvesting it, and an algorithm for choosing between the serratus and subpectoral fascia flaps. Clinical and functional outcomes following use of the subpectoral fascia in expander-based breast reconstruction are reported. METHODS: Thirteen patients (17 breasts) were included in the study. After approval by the institutional review board, retrospective case note analysis was performed for demographic and perioperative factors. Postoperative complications including capsular contracture, seroma, hematoma, wound dehiscence, and infection were recorded. Cadaver studies involving 10 hemichests were undertaken. The subpectoral fascia for each hemichest was dissected and measured for length and width. RESULTS: At a mean follow-up of 589 days (range, 115 to 960 days), seroma occurred in one breast, wound infection occurred in one breast, and minor wound dehiscence occurred in one breast. There were no incidences of capsular contracture or hematoma. The mean +/- SD length of cadaver subpectoral fascia was 148 +/- 26.6 mm and the mean width was 83 +/- 32.1 mm. CONCLUSIONS: The subpectoral fascia flap is a novel and safe option for providing vascularized lateral or inferior coverage of prosthesis in expander-based breast reconstruction. Its harvest and use are not associated with adverse clinical outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".