Breast and Pectoral Muscle Maldevelopment After Anterolateral and Posterolateral Thoracotomies in Children

Anterolateral and posterolateral thoracotomies, involving an incision through the third and fourth intercostal space, have been used for the repair of congenital heart lesions in children during the past thirty years. We examined 28 patients who had undergone repair of atrial septal defect, patent ductus arteriosus, and coarctation of the aorta as children, through the anterolateral or posterolateral chest approach. Volumes of the breasts and pectoral muscles were obtained by a method using plaster molds, and linear dimensions of each chest side were measured. Questionnaires were completed that delineated the patients' perception of asymmetry of the chest. Infant breast tissue on cadavers was examined. We conclude that standard anterolateral thoracotomies result in a high frequency of breast or pectoral maldevelopment; 60% of our patients had a greater than 20% difference in volume between the two sides. We propose a modified operative approach that we believe will reduce the frequency of maldevelopment.