 Using traction and counter-traction, the upper flap was dissected from the chest wall medially to the sternal border, superiorly to the clavicle, laterally to the anterior border of the latissimus dorsi muscle, and superolaterally to the insertion of the pectoralis major muscle. 
Using traction and counter - traction , the upper flap was dissected from the chest wall medially to the sternal border , superiorly to the clavicle , laterally to the anterior border of the latissimus dorsi muscle , and superolaterally to the insertion of the pectoralis major muscle .