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Breast anatomy: Time to classify the subpectoral and prepectoral spaces

Surgical intervention remains the primary treatment modality for most women who develop breast cancer, many of whom require reconstructive surgery. Recent advances, particularly in implant-based techniques (accounting for 40% of breast reconstructions in the UK and 80% in the USA), devices, and biomaterials (ASoP Surgeons, 2012; Albornoz et al., 2013) have led to increases in both classical techniques (e.g., subpectoral breast reconstruction) and more novel techniques such as prepectoral (muscle-sparing) reconstruction. The latter are becoming more popular because the pectoralis major is not detached, so the shoulder dysfunction associated with the classical technique is precluded. In consequence, better understanding of the anatomy of the prepectoral reconstructive plane is required for successful results. With this in mind, we describe the subpectoral and the prepectoral spaces, and further describe a novel way of clinically grading the skin flap vascularity.