Pec Major Late Reconstruction

 Lennard Funk

For chronic ruptures where a direct repair cannot be performed, reconstruction can be considered. This is very rare surgery, as it is not often needed and many with chronic pec injuries can manage, albeit with some activity modifications in some cases. Reconstructions are usually required in heavy manual workers or professional athletes who are unable to perform their jobs due to the injury. It is not recommended for cosmesis or in recreational weight trainers, as it is major surgery with long recovery times and patient expectations need to be realistic.
The aims of the surgery are to improve the pec major strength and relieve the muscle cramping with manual work and sport. Cosmetic improvement is not as reliable as a primary repair procedure. Click here for Outcomes and Complications of surgery.
The surgery is done using a tendon graft. We have found Achilles tendon Allograft to be the strongest and most reliable tendon graft. We also use a modification of this for complex acute repairs that involve the muscle or musculotendinous parts of the pectoralis major. Our technique and results have been published and are online here.

For information on tendon allografts click here.

Animation of our surgical technique:

The post-operative rehabilitation is the same as a primary repair, but it can take longer to achieve maximal recovery (up to one year after surgery).

Javed, S., Monga, P., Hallam, L., Torrance, E., & Funk, L. (2019). Surgical reconstruction of unrepairable pectoralis major rupture using tendo-achilles allograft. Shoulder & Elbow, 11(2), 94–97. https://doi.org/10.1177/1758573217741319