PMC5933572_01
A, Preoperative photo showing breast asymmetry. The left inframammary fold is more inferior than the right inframammary fold. B, Sternalis muscle seen intraoperatively overlying the left pectoralis major muscle parallel to the sternum. C, Patient 8 weeks postoperatively with tissue expanders filled to 550 mL. Symmetry of the pocket was achieved with generous release of the sternalis anatomic variant.
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Intraoperatively, the patient was found to have a left-sided sternalis muscle oriented parallel to the sternum and anteromedial to the pectoralis major muscle (Figure 1).
PMC5933572_02
A, Preoperative anterior view of pectus excavatum in patient with breast cancer. B, Lateral view highlighting midline depression of sternum. C, Postoperative anterior view after bilateral skin-sparing mastectomy with implant-based reconstruction, nipple reconstruction, and fat grafting. D, Lateral view reveals improvement in overall chest contour with reconstructed breasts camouflaging depressed sternum.
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After tissue expansion, she underwent exchange for permanent 650 mL implants and subsequent bilateral nipple reconstruction (Figure 2).
PMC5933572_03
A, Preoperative anterior view of the patient exhibiting curvature of the spine with right shoulder and right inframammary fold higher than left. B, Postoperative anterior view after bilateral deep inferior epigastric artery perforator (DIEP) flaps including elevation of left inframammary fold and improved symmetry of breast volume and nipple location.
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Subsequently, she had bilateral nipple reconstruction (Figure 3).
PMC5933572_04
A, Preoperative oblique photo of patient with polythelia on right. B, Close-up photo with arrow highlighting accessory nipple. C, Postoperative oblique photo after mastectomy and reconstruction including excision of accessory nipple. D, Arrow highlights previous location.
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On physical examination, she was noted to have polythelia on her right breast along the milk line inferior to her primary nipple (Figure 4).