Pectoral facia should be removed during MRM.as described in the initial surgical techniques, and this is the guidelines in our institute , however leaving it totally or partly didn’t show clear evidence of increase incidence of recurrence, specially in early cases that is quite away from the pectoral muscle ( superficial leasions

Hi Awais,

In Venezuela we always remove the pectoral fascia after radical mastectomy, but also in cases of parcial oncologic mastectomy (POM). In POM, we just remove the fascia below the surgical margin.

Preservation of pectoral fascia is not mandatory in every case, choosing the appropriate patient is the most crucial factor.

The tumor which is away from the pectoral fascia has less chances for local recurrence.

Pectoral fascia preservation is safe and has a few advantages like less blood loss, less seroma formation and cosmesis of the skin flaps. It is oncologically safe when compared with pectoral fascia resection, provided appropriate selection of the patient is done.

I prefer not to remove it specially in pt going to recieve radiotherapy. It works as protection

As you know, Pectoralis fascia consists of 4 layers anatomically according to Skandalakis. First, superficial & deep fascia and it is divided into superficial & deep layer again respectively.

In mastecomy, We usually remove all the superficial fascia including retromammay fat tissues sharply off the deep pectoralis fascia.

And, especially In immediate implant reconstruction, Deep pectoralis fascia works as essential implant pocket coverage, so it has to keep its continuity unless the coverage breaks easily.

As a rule, I always remove pectoral fascia during modified radical mastectomy. Oncoplasty procedure may not involve excision of pectoral fascia. Immediate breast reconstruction with implant requires preservation of pectoral fascia.