Objective. To clarify the anatomical features of distal attachment of pectoralis major muscle (PMM) to the ribs and sternum that may be useful in breast augmentation.

Material and methods. We analyzed anatomical features of distal attachment of pectoralis major muscle in 50 patients aged 18—70 years without congenital or acquired chest deformities.

Results. In 62% of cases, sternocostal part PMM distally attached to anterior surface of the sternum, the 5th rib and its cartilage. Lateral (abdominal) part of PMM continued downward and medially towards the 6th-7th and even the 8th rib, where it merged with anterior wall of the rectus sheath. In 28% of cases, PMM attached to the 5th and 6th ribs, abdominal part was also differentiated at the level of the 6th, 7th, and 8th ribs. In 10% of cases, PMM attached to the 5th and 6th ribs. However, abdominal part of the muscle caudal to the 6th rib was not detected during CT.

Conclusion. We hypothesize that preserving the distal attachment of abdominal part of PMM during breast augmentation can ensure an important anchor point for the implant. This can prevent displacement of implant downward and outward. At the same time, mobilization of PMM attachment from anterior sternal surface is inappropriate due to the risk of symmastia.

Keywords. pectoralis major muscle, abdominal part of pectoralis major muscle, breast augmentation, implant rotation