Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Archive for the ‘bicep implants’ Category

Combined Pectoral and Bicep Implants in Men

Monday, October 3rd, 2016


Pectoral implants for male chest enhancement can be a very effective method for a visible change in the size and shape of the pectoralis muscle. Inserted in a completely submuscular position, they push outward on the entire muscle in a largely even distribution of volume. The implants are inserted through a high axillary incision which provides good access for submuscular dissection.

The axillary incision can also provide the opportunity for biceps augmentation as well. Bicep implants are far less commonly performed than pectoral implants. This is due to a general lack of awareness that the procedure exists and that there are no standard styles of bicep implants commercially available.

Bicep implants can be placed either in the intramuscular or the subfascial location. Sitting under the biceps muscle is the coracobrachialis and the brachialis muscle. The implant can be placed directly under the biceps muscle and on top of these two muscles. However, the musculocutaneous nerve from the lateral cord of the brachial plexus runs right through this area and is at risk from compression or a stretch injury. This may lead to loss of muscle strength in the forearm as well as numbness on the radial side of the forearm. For this reason the subfascial location on top of the biceps muscle is preferred.

transaxillary-incision-for-pectoral-and-bicep-implants-dr-barry-eppley-indianapolisUnlike the intramuscular location which requires an incision on the inner aspect of the arm, the subfascial location can be done through the axillary incision. This incision provides equal access to the subpectoral plane medially and the bicep subfascial plane laterally. As the pectoral muscle crosses over the upper border of the bicep muscle the axillary incision provides dual access with equal ease.

custom-pectoral-and-bicep-implants-result-front-view-dr-barry-eppley-indianapoloisBecause of the incisional access, a combined pectoral and bicep implant augmentations can be done during the same surgery. This has the aesthetic benefit of augmenting the two body muscles in men that are most commonly associated with a perception of strength. Despite the same incision this will prolong recovery to some degree as it affects both chest and arm movements across the moveable shoulder joint. But with early physical therapy and range of motion, one should be back to full activities within three to four weeks after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Bicep Implants

Tuesday, September 20th, 2016


Background: Most body implants are done for muscular enhancement. The only exception is that of the female breast implant. In augmenting the muscle size, it is usually most effective if the implant is placed on top of the muscle under its fascial lining. This is certainly true for muscular augmentations that are on the extremities such as the arms and legs. The gliding nature of the muscle inside the fascial sheath allows for a good dissection plane into which the implant can be inserted.

Bicep implants are one of the most uncommon body implants done. While men often seek out larger arm muscles, the appeal of a bicep implant remains limited. This is undoubtably due to the few surgeons that do them and the lack of a good implant which together offers limited public awareness and demand for the procedure. The shape of the bicep muscle is not unlike that of the calfs so the overall implant shape is largely cylindrical.

While there are no true marketed bicep implants, the most common form of them are known as contoured carving blocks. (Implantech) These solid implants come in half cylindrical shapes that go up to 2 cms in length and 6.5 cms wide. The maximal projections are around 2 cms. These implant dimensions will work for most. but not all, patients who seek upper arm augmentation.

custom-vs-standard-bicep-implants-dr-barry-eppley-indianapolisCase Study: This 45 year-old male was to undergo multiple body contouring surgeries, one of which was bicep implants. He was a larger man in stature so even the largest contoured carving blocks were inadequate. Custom bicep implants were made of dimenions 18 cm long, 8 cms wide and 3.5 cm in projection. The attached picture shows the difference between a preformed large bicep implant and that of the custom designed one.

right-biceps-implant-result-intraop-dr-barry-eppley-indianapolisUnder general anesthesia, the custom bicep implants were placed on top of the bicep muscle under the fascia through a high axillary incision.

custom-bicep-implants-result-dr-barry-eppley-indianapolisHis results at two months after surgery show good muscular augmentation with symmetrical implant positioning. The axillary incisions were well healed. He had no restriction of arm flexion or extension. He had just begun back to working out again.

While most bicep implants can be using conventional preformed shapes and sizes, larger men or those that seek more significant arm muscle size may need to consider the custom implant approach.


1) Bicep implants are soft solid implants that are placed in the subfascial location on top of the muscle through an axillary incision.

2) Bicep implants comes in several different sizes but larger dimensions requite a custom implant approach.

3) Custom bicep implants are made based on measurements of the patient arms in the partially flexed position.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Pectoral and Bicep Implants

Wednesday, September 14th, 2016


Background: Augmentation of the male chest can be done by either fat injections or pectoral implants. Fat injections, however, can be unpredictable and often only creates a fuller and rounder chest appearance. Implants produce a much more natural and guaranteed pectoral muscle enhancement effect since they are placed directly under the muscle. By being under the muscle they create a maximal push effect on the entire surface area of the chest portion of the pectoralis major muscle.

Pectoral implants come in several different styles and a variety of sizes that will meet the aesthetic demands of most men who seek chest enhancement. But some patients,  particularly men of bigger statures, may find even the largest of the standard sizes to be aesthetically inadequate. They may need more surface, projection and volume of the implant than is available in preformed implants. Custom implants can be made in almost any size to meet the need for ‘extra large pectoral implants’.

A good complement to pectoral implants is that of bicep implants.  The two muscles are not only adjacent to each other but their augmentations can be done through the same axillary incisions. Bicep implants may be particularly useful when custom pectoral implants are being placed to maintain some proportion to the upper body. Bicep implants are available in either standard or custom implant sizes.

Case Study: This 45 year-old male wanted to dramatically improve the appearance of his upper body. He wanted a very large chest augmentation result as well as that of his upper arms. Custom pectoral implants were designed to have a projection of 5cms with a volume of 896ccs. Custom bicep implants were designed to have a projection of 3.5 cms in height and 235cc in volume.

Under general anesthesia his extra large custom pectoral implants were placed in the completely submuscular position through a high axillary incision of 7 cm. Through the same incision the custom bicep implants were placed in the subfascial plane over the biceps muscle.

extra-large-pectoral-implants-result-fronty-view-dr-barry-eppley-indianapoliscustom-pectoral-and-biceps-implants-result-front-view-dr-barry-eppley-indianapolisHis result shows the dramatic effect that can be obtained with larger pectoral and bicep implants that are custom made. The ultrasoft solid silicone gel material allows very large implants to be inserted through relatively small incisions. The soft gel will initially feel firm due to swelling but will soften over the first few months after surgery.


1) Pectoral and bicep implants done together can create a dramatic upper body augmentation result.

2) Pectoral and bicep implants are placed through the same high axillary incision.

3) Pectoral and bicep implants come in standard sizes or can be custom made to best achieve the patient’a aesthetic needs.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Bicep Implants

Wednesday, July 20th, 2016


bicep muscleBackground: The bicep muscle is the most recognized muscle of the entire arm as evidenced by someone flexing their arm to show its presence. It is a two-headed muscle that runs between the shoulder and the elbow. It has two distinct heads, known as the short and long heads, which emanate from the scapula of the shoulder. The two heads come together into a single muscle mass by the mid-portion of the upper arm. From there the muscle extends across the elbow and attaches to the radius of the forearm.

Augmentation of the bicep muscle can be done by fat injections or an implant. While both treatment methods can be effective, a biceps implant offers a reliable and permanent muscular enhancement method. These implants can inserted either under the muscle (intramuscular) or on top of it just under the fascia. Because of potential injury to the musculocutaneous motor nerve, it is preferable to opt for the subfascial placement on top of the muscle. This also creates the most visible muscle enhancement effect.

Bicep Implants Dr Barry Eppley IndianapolisThere are no formal silicone bicep implants per se. Most commonly used are either silicone calf implants or contoured carving blocks. (Implantech) Their long cylindrical shapes matches the longitudinal shape of the arm muscle. Such performed implants can achieve a 2 cm increase in muscle profile. For larger bicep implants, a custom design process must be used.

CCB3 Custom 18x 8 x 4 3D-R02-1Case Study: This middle-aged male wanted a significant biceps muscle enhancement. Given his large body frame (over 6’ 4” tall) and weight, all standard sized bicep implants were inadequate to make surgery worthwhile… or least not enough to meet the patient’s aesthetic goals. A pair of custom bicep implants were designed and made to exceed the dimensions of standard sized implants used for the biceps. These custom implants were different largely in thickness and width, the length stays the same as other implants.

Bicep Muscle Shortening Dr Barry Eppley IndianapolisWhen doing the preoperative markings for a bicep implants or in the design of custom bicep implants, it is important to appreciate how the muscle belly shortens as the arm flexes. The maximum implant length should not exceed the proximal-distal length of the muscle when in flexion. (hand bend back to the shoulder)

Bicep Implant placement technique Dr Barry Eppley IndianapolisUnder general anesthesia a 4 cm axillary incision was made in the anterior axillary skin crease. Deeper dissection led to the biceps fascia which was opened and a subfascial pocket developed. The custom bicep implants were inserted and positioned directly on top of the muscle. The fascia was closed over them as well as multiple layers beneath the skin.

Bicep Implant immediate result Dr Barry Eppley IndianapolisRight Biceps Implant result intraop Dr Barry Eppley IndianapolisThe change in arm size was immediately apparent as would be expected. Due to the soft durometer of the implants they felt fairly similar to muscle.

Custom bicep implants can be used when a bigger size is needed than what standard implants provide. In men with larger body frames a higher profile (projection) and width may be needed to create an adequate muscle enhancement effect.


1) Biceps implants are placed on top of the existing muscle for an enhanced upper arm profile.

2) Placed through an axillary incision, the implant is placed under the overlying fascia of the biceps muscle.

3) Custom bicep implants are bigger than standard sized implants but are placed the same way.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

Read More

Free Plastic Surgery Consultation

*required fields

Military Discount

We offer discounts on plastic surgery to our United States Armed Forces.

Find Out Your Benefits