Body contouring surgery
Body contouring surgery aims to reshape the silhouette by creating more harmonious curves.
Dr. David specializes in cosmetic and reconstructive surgery, and frequently performs the four procedures listed below.
Visit LIPOSUCCION aims to remove localized excess fat that is difficult to reduce by diet. Dr. David uses the Lipomatic, which enables better-quality fat suction.
The results of liposuction are good when the skin is of good quality and when excess fat is well localized. The best areas for liposuction are the saddlebags, flanks, thighs and abdomen.
L'ABDOMINOPLASTY is designed to repair aesthetic disfigurements of the abdomen. After pregnancies or massive weight loss, the skin of the abdomen is relaxed, which can cause functional and aesthetic discomfort. Abdominoplasty removes excess skin to restore a flat stomach.
Visit BRACHIAL LIFT aims to treat excess fat and sagging skin by liposuction of the inner arm and skin plasty. The brachial lift is used to treat sagging arms, with generally good results but some scarring.
Visit CRURAL LIFTING aims to treat excess fat and sagging skin by liposuction of the inner arm and skin plasty. A femoral lift can be performed in two ways:
1 horizontal scar in the groin fold to tighten the skin of the upper third of the thigh.
1 vertical scar, more visible but which tightens the skin of the entire thigh.
L'BUTTOCK AUGMENTATION helps restore a harmonious shape to the buttocks. There are a number of ways to regild the buttocks:
Injection of "macrolane" hyaluronic acid.
Injection of fat taken from the flanks and saddlebags to regenerate the buttocks.
Insertion of silicone prosthesis.
Plastic and aesthetic surgery: Anatomy
In plastic surgery, a precise knowledge of the anatomy of the pectoral nerves is essential when performing a surgical procedure. mastectomy/The aim is to avoid iatrogenic sectioning of the implant during axillary surgery and when fitting a breast prosthesis via the axilla.
We have seen that of the three branches that innervate the pectoralis major muscle, only two (the inferior and middle branches) are likely to be severed during an axillary approach, which rules out total denervation of the pectoralis major muscle when performing these two procedures.
However, it remains possible to transect either the inferior branch or the inferior and middle branches of the pectoral nerves during an axillary approach.
Isolated section of lower branch
Sectioning of the inferior branch of the pectoral nerves is a frequent occurrence in axillary surgery, due to its anatomical situation, but it causes few sequelae. Indeed, authors who have studied the consequences of sectioning the inferior branch of the pectoral nerves have reported a slight reduction in the strength of the pectoralis major muscle, but no reduction in the muscle mass of the pectoralis major muscle, or in the shoulder's range of motion in flexion or abduction.
The lack of functional consequences following sectioning of the inferior branch of the pectoral nerves prompted Hoffman and Elliot to recommend its voluntary sectioning to reduce contractions of the lower part of the pectoralis major muscle, with the aim of facilitating postoperative positioning of breast prostheses.
Lower and middle branch section
In everyday practice, a lesion of the lower and middle branches of the pectoral nerves is not a common problem.
However, this is a problem worth considering, as the middle branch of the pectoral nerves runs along the deep surface of the pectoralis major muscle, close to the pectoral branches of the thoracoacromial artery and vein, and damage to these vessels will result in ligation or electrocoagulation, which may damage the middle branch of the pectoral nerves.
Sectioning the lower branch of the pectoral nerves alone produces virtually no after-effects, but sectioning both the lower and middle branches results in much greater after-effects.
In 1980, Moosman reported on the sequelae of Patey radical mastectomy after resection of the pectoralis minor muscle, describing atrophy, fibrosis and shortening of the lower third of the pectoralis major muscle, limitation of shoulder joint amplitudes and cosmetic changes in the sub-mammary fold.
Moreover, Merson et al. in 1992 described a 54% reduction in pectoralis major muscle mass in the case of resection of the pectoralis minor muscle in radical mastectomies, compared with a 6% reduction in pectoralis major muscle mass in mastectomies with preservation of the pectoralis minor muscle[33].
The sequelae described by these two authors after resection of the pectoralis minor muscle cannot be due to section of the inferior branch of the pectoral nerves alone, given the multiple innervation of the pectoralis major muscle and the minimal sequelae after section of the inferior branch alone reported by various authors.
Like Scevola et al., we believe that the significant sequelae reported by these two authors were caused by transection of the lower and middle branches of the pectoral nerves during resection of the pectoralis minor muscle.
C.Approach to axillary breast implants
Our results confirm Tebbets' recommendation that deep axillary dissection should only be performed above a line 1 cm posterior and parallel to the lateral border of the pectoralis major muscle. Dissection anterior to this line to reach the pectoralis major muscle and create a prosthetic pocket avoids the noble structures on the inner surface of the axillary fossa.
Descriptive anatomy of the pectoral nerves
Spinal origin of the pectoral nerves
One of the main points of discussion is the spinal origin of the pectoral nerves. For Moore and Dalley, the C6 root was the root giving the main innervation to the pectoral nerves[3]. For Lee, on the other hand, the C7 root supplied nerve fibres to all the branches of the pectoral nerves, and played a major role in their innervation[32]. For this author, the superior branch was composed of nerve fibers originating from C5-C6-C7, the middle branch was composed solely of nerve fibers originating from C7, and the inferior branch was composed of nerve fibers originating from C8-T1 and C7 via the pectoral loop.
Our results concur with Lee's findings. In line with these findings, the middle branch of the pectoral nerves can be used as a donor nerve in C5-C6 brachial plexus palsies, and the lower branch of the pectoral nerves can be used as a donor nerve in C5-C6-C7 brachial plexus palsies. However, the upper branch cannot be used as a donor nerve in upper brachial plexus paralysis.
Truncal origin and routes of the pectoral nerves
In our study we found three constant branches of the pectoral nerves having three distinct origins in 3⁄4 of cases and two distinct origins in 1⁄4 of cases. Our results go against the classical description of pectoral nerves, indeed in the international anatomical nomenclature there are only two pectoral nerves, the lateral pectoral nerve and the medial pectoral nerve. In international anatomical nomenclature, the lateral pectoral nerve is named after its lateral origin in the brachial plexus, and the medial pectoral nerve is named after its medial origin in the brachial plexus. This name leads to confusion, as the lateral pectoral nerve has a medial course on the chest wall, while the medial pectoral nerve has a lateral course on the chest wall. As a result, some surgeons name pectoral nerves according to their origin, others according to their course.
Our results confirm the conclusions of Aszmann et al. that there are indeed 3 branches of the pectoral nerves[2-6], which we have named superior, middle and inferior for the sake of clarification. On the other hand, we found considerable variability in the truncal origin of the superior and middle branches of the pectoral nerves, which is at odds with the results of Aszmann et al.