Surgical and Radiologic Anatomy

, Volume 25, Issue 3–4, pp 311–314 | Cite as

Sternalis muscle: importance in surgery of the breast

Original Article

Abstract

Mastectomy is a commonly performed surgery for carcinoma of breast. During surgery, pectoral fascia is removed and pectoralis major muscle is laid bare. Sternalis is a rare muscle encountered in the subcutaneous plane. We examined the operative records of 1,152 patients who underwent modified radical mastectomies between 1990 and 2000. Patients who underwent conservative breast surgery or radical mastectomy were excluded. Among 1,152 patients who underwent modified radical mastectomy, eight were identified as having sternalis, a subcutaneously placed muscle oriented craniocaudally. The thickness of the muscle varied. The muscle was spared in all patients. Sternalis is a rare muscle in the subcutaneous plane. It should not be mistaken for a mass on mammography. During surgery it is important to be aware of this rare entity and identify the muscle early so that the dissection plane is appropriate. The depth at which internal mammary nodes are irradiated may also vary in the presence of the muscle. In addition, it should not be mistaken for recurrence on follow-up.

Keywords

Carcinoma breast Mammography Mastectomy Radiotherapy Sternalis 

Résumé

La mastectomie est le procédé chirurgical le plus souvent réalisé pour traiter le cancer du sein, comportant l'ablation du fascia du muscle grand pectoral qui est mis à nu. Le muscle sternal est rarement retrouvé dans le plan sous-cutané. Sur un total de 1,152 mastectomies radicales modifiées (1990–2000), excluant les gestes de conservation mammaire et les mastectomies radicales classiques, un muscle sternal sous-cutané, à orientation crânio-caudale et d'épaisseur variable, a été trouvé dans 8 cas et toujours préservé. Le muscle sternal peut être confondu avec une tumeur sur la mammographie. Il est important de le repérer rapidement dans le plan sous-cutané pour utiliser le bon plan de clivage. Il peut modifier la technique d'irradiation des noeuds lymphatiques parasternaux et être considéré à tort comme une récidive tumorale.

Supplementary material

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French version of the article (PDF 27 KB)

References

  1. 1.
    Adachi B (1887) On the examination of the M. sternalis in the living persons. Tokyo Igakkai Zasshi 11: 57–65Google Scholar
  2. 2.
    Bailey PM, Tzarnas CD (1999) The sternalis muscle: a normal finding encountered during breast surgery. Plast Reconstr Surg 103: 1189–1190PubMedGoogle Scholar
  3. 3.
    Barlow RN (1935) The sternalis muscle in American Whites and Negroes. Anat Rec 61: 413–426Google Scholar
  4. 4.
    Blees G (1968) A peculiar type of sternalis muscle. Acta Morphol Neerl Scand 7: 69–72PubMedGoogle Scholar
  5. 5.
    Bradley FM, Hoover HC Jr, Hulka CA, et al (1996) The sternalis muscle: an unusual finding seen on mammography. AJR Am J Roentgenol 166: 33–36PubMedGoogle Scholar
  6. 6.
    Cunningham DJ (1888) The musculus sternalis. J Anat Physiol 22: 391–407Google Scholar
  7. 7.
    Futai K (1927) On the sternalis of the living human. Juzenkai Zasshi 32: 7Google Scholar
  8. 8.
    Futai K (1931) On the sternalis of the living human. Juzenkai Zasshi 36: 399–405Google Scholar
  9. 9.
    Jeng H, Su S (1998) The sternalis muscle: an uncommon anatomical variant among Taiwanese (letter). J Anat 193: 287–288Google Scholar
  10. 10.
    Kacker GN (1960) Sternalis muscle in U P Indian subjects. J Anat Soc India 9: 101–103Google Scholar
  11. 11.
    Kida MY, Izumi A, Tanaka S (2000) Sternalis muscle: topic for debate. Clin Anat 13: 138–140CrossRefPubMedGoogle Scholar
  12. 12.
    Kida MY, Kudoh H (1991) Innervation of the sternalis muscle accompanied by congenital partial absence of the pectoralis major muscle. Okajimas Folia Anat Jpn 67: 449–455PubMedGoogle Scholar
  13. 13.
    Kirk TS (1924–1925) Sternalis muscles (in the living). J Anat 59: 192Google Scholar
  14. 14.
    Kitamura S, Yoshioka T, Kaneda M, et al (1985) A case of the congenital partial defect of the pectoralis major accompanied by the sternalis with enormous size. Kaibogaku Zasshi 60: 728–732PubMedGoogle Scholar
  15. 15.
    Misra BD (1954) The sternalis muscle. J Anat Soc India 3: 47–48Google Scholar
  16. 16.
    Murphy JS, Nokes SR (1996) Radiological case of the month. Sternalis muscle. J Ark Med Soc 93: 55–56PubMedGoogle Scholar
  17. 17.
    O'Neill MN, Folan-Curran J (1998) Case report: bilateral sternalis muscles with a bilateral pectoralis major anomaly (letter). J Anat 193: 289–292Google Scholar
  18. 18.
    Patten CJ (1933-1934) Right sternalis muscle with expanded and fenestrated tendon. J Anat 68: 424–425Google Scholar
  19. 19.
    Rao VB, Rao GRKH (1954) The sternalis muscle. J Anat Soc India 3: 49–51Google Scholar
  20. 20.
    Sato I, Ueno R, Sato T (1984) The anomalies of the sternalis muscle. Shigaku T 72: 489–492Google Scholar
  21. 21.
    Shah AC (1968) The sternalis muscle. Indian J Med Sci 22: 46–47PubMedGoogle Scholar
  22. 22.
    Shen CL, Chien CH, Lee SH (1992) A Taiwanese with a pair of sternalis muscles. Kaibogaku Zasshi 67: 652–654PubMedGoogle Scholar
  23. 23.
    Takafuji T, Igarashi J, Kanabayashi T, et al (1991) The muscular arch of the axilla and its nerve supply in Japanese adults. Kaibogaku Zasshi 66: 511–523PubMedGoogle Scholar
  24. 24.
    Turner W (1867) On the musculus sternalis. J Anat Physiol 1: 246–253Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of Surgical OncologyM.S. Ramaiah Medical College & HospitalBangaloreIndia
  2. 2.#2866, 13th MainBangaloreIndia
  3. 3.Bangalore Institute of OncologyBangaloreIndia

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