Clinical and anatomical rationale for the loop method in reconstructive and aesthetic breast surgery

Objective. To describe planar anatomy of pectoral region during suture passage for loop formation. Material and methods. Anatomical study was conducted on 5 female cadavers. A loop was performed using a 110 cm long suture 0 and 35 cm long metal passer (diameter 3 mm). We passed sutures in soft tissues surrounding the breast according to original approach. After suture placement, we performed anatomical dissection of soft tissues while preserving suture track. Its position relative to superficial and underlying structures was assessed. Results. In subclavian region, suture passed through deep layers between superficial and deep fascia within subcutaneous adipose tissue. Near the lower third of the sternum, suture passed along the midline anchored to deep fascial layers of sternal region. Then, suture followed the gradient and transitioned to superficial subdermal layer either along the entire length of inframammary fold or with interruption in this track. Afterwards, suture passed into deep layers of soft tissues beneath the deep fascia and ascended along the lateral surface of the chest towards axillary region. Then, suture passed under the pectoralis major muscle. The loop was completed at the entry point. Conclusion. Formation of inframammary fold using loop technique is an important tool in breast surgery, as it allows for minimally invasive creation of stable structure, forms thoraco-mammary angle of necessary depth and simultaneously augments breast spot tissue.