Implants are most commonly used for aesthetic augmentation of numerous muscle areas of the body. These include the chest (pectoral implants), calfs (calf implants), and buttocks. (gluteal implants) Less frequently performed, although no less successful, is that of the upper extremity of the biceps and triceps muscle.
One other muscular augmentation area of the upper extremity is that of the deltoid muscles. Known as the shoulder muscle, it is mass of three muscle bellies that provide width to the shoulders. While deltoid implants can be made from modifications to contoured carving blocks, it is a difficult area to get implant positioning from a remote incision.
When possible deltoid augmentation should be initially attempted by fat injections. My experience has been that fat injected into the deltoid muscles has a decent rate of survival and retention. It also has the aesthetic benefit that its augmentation effect creates a broader surface area enhancement which is more comparable to the wider shoulder area.
Fat injection deltoid augmentation is done primarily subfascial and into the muscle. The subcutaneous tissues over the shoulder are usually fairly thin. All three deltoid muscle bellies should be injected. The usual fat volume injected is between 150cc to 300ccs per shoulder area.
Whether fat injection deltoid augmentation should be done over deltoid implants depends on how much fat the patient has to harvest. Because of the lower concentration rates of fat harvests in men, one should have at least 500cc to 750cc in harvest volume.
The treatment options for small shoulders or lack of adequate/desired deltoid muscle size has historically been the placement of implants. True deltoid implants as an off-the-shelf device does not exist due to lack of patient demand. But when a patient does request deltoid implants, they can be done using other modified body implants or they can be custom made.
As an alternative option to implants for deltoid/shoulder augmentation, injectable fat can be used. Its use is predicated on whether the patient has enough fat to harvest to make the procedure worthwhile and the patient’s acceptance of wide variability of injected fat survival. Since men make up every deltoid augmentation patient I have ever seen, the fat donor sites are the traditional stomach and flanks (love handle) areas. Deltoid augmentation by fat injections provides a potentially pleasing dual benefit of abdominal and waistline reduction and an increase in shoulder size. (a body inversion if you will)
When injecting fat into the deltoid shoulder area, I prefer to use a triangulation technique through three distinct entrance sites. The fat is injected both above the fascia in the subcutaneous fat as well as into the deltoid muscle below the fascia in small linear tracts of deposited fat. It usually takes about 100cc to 150cc per shoulder to produce an optimal amount of augmentation. For both shoulders this is a total amount of fat needed in the range of 250cc to 300cc. Since lipoaspirated fat must be concentrated prior to injection and such concentrations in men produce yields of 20% to 25% of the aspirate due to the higher fibrous content of their fat, it is necessary to ideally obtain at least 750cc to 1000cc of fat aspirate.
Since the shoulders are curved, injecting fat into them is best done with a similarly curved injection cannula. This allows the fat to be injected is the most even fashion possible whether above or below the deltoid fascia.
Deltoid augmentation with fat injections is a good alternative to implants that can be successful if one has enough donor fat. Optimal fat take requires a good concentration method and distribution of the fat by small linear track layering both above or below the deltoid muscle fascia
Muscular enhancement of certain body parts can be done through the use of synthetic implants. Everyone knows about breast implant augmentation although this is not a true muscular enhancement but a breast tissue enlargement. Historically the most recognized body implants were for the chest, buttocks and calfs. The number of such implants combined pale in comparison to the number of breast implants that are placed but that makes them no less useful.
The number of body implant surgeries that are performed have continued to increase over the past decade. Greater awareness and acceptance of body augmentations has fueled demand as well as improvement in implant materials and surgical techniques. Body implants, unlike breast implants, are made of a solid but very soft and compressible silicone elastomer material. This makes them capable of being inserted through small incisions and to have a feel that is similar to what they intended to enhance…muscle. Because they are a completely polymerized non-liquid material they will never rupture, degrade or need to be replaced.With these better materials has come an expansion of body implants to new and innovative areas of augmentation. These have included such areas as the arms, shoulders and even the hips to create muscle prominences and increased curves.
Muscle implants are used to surgically build-out an underdeveloped area of muscle in the body. These muscle deficiences can be caused by a birth defect, a traumatic injury, or an aesthetic desire for body shape improvement. Aesthetic desires for body implants (pectoral, calf, arm implants) comes from an inability to build up the muscle adequately from exercise. There are also recent fashion and body image trends for an increased gluteal size. (buttock implants) Birth defects can also drive the need for implants and include club foot and Spina Bifida for calf implants, chest wall deformities from Pectus and Poland’s syndrome for pectoral implants and Sprengel’s deformity for deltoid implants.
An overview of old and new body implants includes the following.
PECTORAL IMPLANTS Male chest enhancement is done by transaxillary implant placement under the pectoralis major muscle but staying within the outline of the muscle. (unlike breast implants) They are available in different oval and more square shape forms.
BUTTOCK IMPLANTS Intramuscular or subfascial pocket placement in regards to the gluteus maximus muscle is used for implant location. I prefer the intramuscular location to reduce the risk of potential complications even if it poses size limitations (< 400ccs implant volume) and a longer recovery.
CALF IMPLANTS Being the smallest of all body implants, they have a cigar-type shape that are available in different lengths, widths and thickness. They may be used to build up the inside of the leg (medial head gastrocnemius muscle) or combined with outside of the calf augmentation as well. (lateral head gastrocnemius muscle)
ARM IMPLANTS The top (biceps) and bottom (triceps) of the arm can be build up for those men that either can’t get enough muscle bulk by exercise alone or want to maintain a more muscular arm shape with less long-term exercise maintenance.
DELTOID IMPLANTS While there are no true shoulder implants, they can be made by either modifying existing body implants used for other areas or hand making the implants from performed silicone blocks.
HIP IMPLANTS Placing implants placed below the muscular fascia below the prominence of the greater trochanter of the hip can build out an otherwise straight leg line.
Body implant surgery is both safe and effective when done by a surgeon who has good experience with these materials and has anatomical knowledge of the different and varied parts of the body where these implants go. While fat injection augmentation has a valuable role in the enhancement of certain body areas also, synthetic implants offer a permanent and assured solution to body augmentation that has the trade-off of an implanted material and a longer recovery.
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.