The medial pectoral nerve, despite its name, supplies both pectoral muscles by first passing through or around the pectoralis minor to enter the pectoralis major from its deep surface. Preserving the medial and lateral pectoral nerves is important during subpectoral breast implant placement to maintain pectoralis major function and avoid nerve injury from compression or stretching during dissection.
| Origin | Medial cord of the brachial plexus (C8, T1) |
|---|---|
| Course | Passes forward between the axillary artery and vein, joins a loop (ansa pectoralis) with the lateral pectoral nerve, supplies and usually pierces pectoralis minor, and enters the deep surface of pectoralis major |
| Motor | |
| Sensory |
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Both pectoral nerves can be stretched during superior dissection in breast augmentation, producing pectoralis major weakness and animation deformity when the implant moves with muscle contraction; the medial pectoral nerve is more at risk in medial and inferior pocket dissection. Near the coracoid it can be injured during pectoralis minor release and subpectoral biceps tenodesis. Injury weakens the lower pectoralis major and pectoralis minor. Because it comes from the medial cord (C8, T1), EMG of the lower pectoralis major helps localise brachial plexus injuries.
Iatrogenic stretch or division during breast surgery producing pectoralis major weakness and animation deformity of the breast implant, managed with nerve-sparing surgical technique.
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