Topic Overview

Deep Fascia of the Pectoral Region

Pectoral Fascia

• Thin layer covering the pectoralis major muscle.

• Superiorly → attaches to clavicle.

• Medially → to sternum.

• Inferiorly → continues with anterior abdominal wall fascia.

• Laterally → forms axillary fascia (floor of axilla).

• Clinical: provides a plane for spread of infections or abscesses from chest wall to axilla.

Clavipectoral Fascia

• Strong fascia deep to pectoralis major, enclosing subclavius and pectoralis minor.

• Extent:

  • Superiorly → splits to enclose subclavius, attaches to clavicle.

  • Inferiorly → splits around pectoralis minor, continues as suspensory ligament of axilla (maintains concavity of axilla).

• Pierced by:

  • Cephalic vein.

  • Thoracoacromial artery and vein.

  • Lymphatics from breast to apical nodes.

  • Lateral pectoral nerve.

Axillary Fascia

• Continuation of pectoral fascia laterally.

• Forms the floor of axilla along with skin and subcutaneous tissue.

• Suspended by the suspensory ligament of axilla (extension of clavipectoral fascia).

Clinical Importance

• Clavipectoral fascia → key landmark in surgical procedures; incised during axillary clearance.

• Suspensory ligament of axilla → maintains hollow of axilla; loss of elasticity causes axillary sagging.

• Infections/abscesses can track along deep fascia planes into axilla or anterior chest wall.

• Cephalic vein cutdown and central line placements → require piercing clavipectoral fascia.