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Archive for the ‘pectoral implants’ Category

Avoiding Common Male Pectoral Implant Complications

Tuesday, January 23rd, 2018

 

The enhancement of the male chest has some obvious differences from that of the female chest. In women the goal is to make a larger mound that sits on top of the muscle. Conversely in men, the goal is to enhance the size and projection of the deeper pectoralis major muscle. As a result the resultant change in chest topography has very different desired augmentation shapes. This would indicate that not only should the size and shape of the implants needed would be different but that the created pockets would also similarly be different.

Having placed many pectoral implants and also treated numerous pectoral implant problems performed by other surgeons, there is a consistent pattern of fundamental errors in surgical technique that I have observed . They can be divided into incision placement, pocket dissection and implant shapes/dimensions.

Like transaxillary breast augmentation in women, pectoral implants in men are placed through similar incisions. While the incision will almost always be longer than that used for breast implants, it needs to be placed high up in the axilla in a skin fold under the lateral pectoral muscle border. Some surgeons, for reasons not completely explainable, place the incision much lower along the chest wall. This makes the incision very visible and impossible to redocate. It should never be placed in this low visible location. Its only ‘advantage’ is that it makes pectoral implant revision easier particularly if pocket plication for reduction is needed.

Once of the basic differences between breast and pectoral implants is the margins of the pocket. In breast implants the effort is to make a rounder mound that needs the submuscular pocket to go behind the lateral border of the pectoral muscle to do so. (and even open up the bottom of the muscle to enable implant placement ideally centered behind the nipple) In male chest augmentation the lateral pectoral border must not be disrupted. Examination of ideal male chest shapes reinforce the precise that this is a muscle augmentation procedure and to optimally do so the implant must stay within the muscle borders. The goal is not to center the implant behind the nipple. Rather the male nipple is located at the bottom edge of the muscle/implant edge. It is not uncommon to see pectoral implants where the implant sticks out beyond the lateral muscle border, creating more of a flatter breast mound rather than a complete muscle augmentation.

Pectoral implants come in several different shapes but they fundamentally come down to oval vs more of a rectangle. In looking at the shape of the pectoral muscle most men seek a more rectangular augmentation which augments the whole muscle. The lateral pectoral border is not straight but curved. A pure rectangular shape should only be used for the man who wants a straighter and not curved lateral pectoral margin. Preoperative measurements should be done from the sternal margin out to the lateral pectoral border and the implant width chosen on that basis. Some pectoral implants have tails that go up to the edge of the lateral pectoral border of the axilla at the thickest part of the muscle. Whether this has a useful augmentation effect canoe debated but at the least it may help with implant orientation.

Male pectoral implants can be just as successful as that of breast implants in women. Technically it can be more successful long-term since pectoral implants have no risk of rupture.deflation and ever needing replaced due to device failure. Following several basic principles of the incision, pocket creation and implant selection will avoid most common pectoral implant problems.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Funnel Insertion Technique for Pectoral Implants

Sunday, January 21st, 2018

 

Pectoral implants are the male equivalent of breast implants for women. While done far less frequently, as men can build their pectoral muscles by exercise, they are very effective at enhancing the size of the pectoral muscle through placement behind it. They are actually done more often in men that workout than in men who don’t contrary to popular perception.

Unlike breast implants, the only aesthetically acceptable incision for pectoral implant insertion is through the axilla. A high transaxillary incision is used as, it not only keeps the scar off the chest wall, but is the shortest distance to the submuscular space under the pectoralis major muscle. At this point close to the arm the pectorals major muscle is most widely separated from the pectorals minor muscle. This allows for the easiest entrance to the submuscular space without having to disrupt any of the lateral pectoral muscle attachments except right next to the axilla. This ability alone is paramount as this is the key difference in pocket creation between pectoral implants in men and breast implants in women.

The size of the transaxillary incision for pectoral implants is larger than when used for the insertion of breast implants. It will usually be about 5 cms for most standard pectoral implant sizes. But as more and more custom pectoral implants are being used, their larger sizes makes keeping the incision a reasonable length more difficult. This is where borrowing a concept from breast implants is useful, the funnel insertion technique.

The well known funnel device allows a soft gel-filled breast implant to be inserted through a small incision by controlling its deformation through uniform compression out a smaller end hole than the diameter of the implant. This concept works equally well for pectoral implants. While a pectoral implant is more solid than a gel-filled breast implant it works equally well. The pectoral implant is folded onto itself and placed in the funnel.

By inserting the end of the funnel under the pectorals major muscle lateral border, it is squeezed through the incision and into the sub muscular space.

Once into the pocket it is necessary to manually unfold and position the implant. Since most pectoral implants do not have a completely symmetric shape their orientation is important in the pocket to achieve the desired external effect. (this is unlike round breast implants whose orientation is irrelevant) The funnel insertion technique for pectoral implants not only keeps the axillary incision size not unduly long but also prevents potential tearing of the soft durometer material.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Pectoral Implants Replacements

Thursday, November 30th, 2017

 

Background: The equivalent to female breast augmentation in men are pectoral implants. Besides the obvious differences in aesthetic objectives, pectoral implants differ in that they are solid devices that are placed completely in a submuscular position within the confines of the borders of the pectoralis major muscle. This is almost always done through a transaxillary incisional approach.

Like breast implants, pectoral implants can develop the same complications such as implant malposition and size and shape concerns. Choosing the correct pectoral implant style and size is an art form that belies an exact science to it. Most men today want a chest that has a more rectangular shape that adds visible fullness to the sternal border of the muscle as well in the superomedial pole of the chest. Implant projections range from more modest amounts of 2 cms or so up to 3.5 to 4cm.

One indication for pectoral implants is in cases of corrected precuts excavatum. Even in near optimal corrections the chest is often flat and lacks visible muscle definition. The muscle is often underdeveloped and may have a smaller shape due to an aberrant origin along the sternum/ribcage. The use of pectoral implants in asymmetric chests have a high risk of malpositions and magnifying such pre-existing chest asymmetries.

Case Study: This male patient had previously undergone a Nuss procedure for correction of his precuts excavated. This left lateral chest wall scars. He then had pectoral implants placed through these same scars but developed asymmetry in the appearance of is chest. he was uncertain about the exact shape and size of his pectoral implants. A 3D CT scan showed that the right pectoral implant was rotated 90 degrees and was sitting lower as it extended beyond the lateral pectoral muscle border.

In considering his pectoral implant replacements, custom implants were designed that had a better shape for his chest but with a similar projection to his indwelling implants.

Under general anesthesia his existing pectoral implants were removed through the lateral chest wall incisions. Both implant pockets had a fluid collection which was greater on the right than the left. The removed implants could be seen to have been modified on their underside and the right implant had tears in two locations. The pockets were cleaned and irrigated and the new implants placed. The lateral border of the right pectoral muscle was re-established/tightened using permanent sutures to the ribcage.

This case represents two observations. First, while all solid body implants can be altered, doing so removes the outer shell of the implant exposing the tissues to the sifter inner gel. This can be a potential source for irritation and the development of chronic serums. When possible it is best to not cut into preformed solid body implants. Secondly, custom pectoral implants are ideal when treating chest wall asymmetries that have either been previously implanted or are being treatment planned for the first time.

Highlights:

1) Asymmetry in pectoral implants can be the result of implant positioning or differences in the natural chest anatomy.

2) When in doubt about pectoral implant positioning and style/size, a 3D chest CT scan can help identify the problem.

3) Custom pectoral implants can be an effective solution to chest asymmetry after implant augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Extra Large Custom Pectoral Implants

Saturday, July 22nd, 2017

 

Pectoral implants are the primary method of male chest enhancement. Placed on top of the ribcage, they are intended to increase the volumetric effect of what lies over them…the pectoralis major muscle. Because it is a muscle enhancing implant and not a mound creator like breast implants, the tissue pocket for pectoral implants should not violate the lateral pectoral muscle border. This keeps the implant contained in a tighter space and within the borders and outline of the pectoralis major muscle.

Because it is a muscle enhancement procedure the shape of pectoral implants is not a round sphere like that of breast implants. Its shape should mimic that of the overlying muscle which is fan-shaped and more like a rectangle than a sphere. It will also have a much lower profile than that of breast implants, often providing a few centimeters of projection.

While there are several options in pectoral implant shapes and thicknesses, such performed implants will not work well for every patient. For those men seeking larger chest augmentation results due to their body size or personal desires, a custom implant approach is needed. Such custom designing can make for extra large (XL) pectoral implants when compared to standard implants sizes.

While the implant ‘footprint’ or height and width dimensions are bigger than that of standard implants, what really separates custom pectoral implants is their projection. (thickness) Even in larger men the surface area coverage of the implants needed can only be so much different. But it is the increased thickness that can really make the difference in the augmentative effect. Custom designing also allows various thicknesses along different regions of the implant a greater upper pole effect.

Extra large custom pectoral implants can pose challenges for insertion through an axillary skin incision. But their very low durometer and flexibility allows them to be inserted with a funnel device which prevents the creation of tears or fractures in the implant.

Dr. Barry Eppley

Indianapolis, Indiana

Clinic Snapshots – Pectoral Implants with Abdominal Etching

Monday, December 26th, 2016

 

The principal method to augment the male chest is with the use of pectoral implants. Like in the female breast, the placement of a pectoral implant creates an immediate chest enlargement. The fundamental difference between a female and make chest implant is that one is a fluid-filled device while the other one is solid. The male pectoral implant is designed to completely replicate muscle and therefore can be more firm. Conversely a breast implant is designed create a breast mound that is softer and more supple.

Pectoral implants come in a variety of sizes with several shape choices. With standard volumes sizes now up to over 600ccs significant chest enhancement cab be achieved in just about any male regardless of their size. As a solid implant they have a low durometer which not only makes the feel much like muscle but also allows them to be introduced through a high axillary incision as well.

pectoral-implants-and-abdominal-etching-result-front-view-dr-barry-eppley-indianapolisA good complement for the male chest enhancement patient is that of abdominal liposuction or abdominal etching. Since they can both be performed in the supine position it is a good opportunity for a ‘male maleover’ with combined chest and abdominal reshaping.

The creation of a ‘six-pack’ is a form of liposculpture using focused fat removal along specific lines. Designed to replicate the appearance of the abdominal inscriptions, etching mimics those lines by creating a dermal-fascial adhesion. Abdominal etching works best in the thin patient. But it can be done at the same time as overall liposuction in men with thicker subcutaneous abdominal wall layers albeit with not the same abdominal etch line definition as in thinner men.

Dr. Barry Eppley

Indianapolis, Indiana

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 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.

Highlights:

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

Repositioning of Pectoral Implants

Monday, September 12th, 2016

 

Pectoral implants in men is the equivalent of breast implants in women. Both serve to enhance the chest appearance in their respective genders. But beyond this general concept, pectoral implants and breast implants are very different.

pectoral-implant-augmentation-dr-barry-eppley-indianapolisOne major difference is the such implants in men are for muscular augmentation. As such it is placed below the pectoralis major muscle. But unlike breast implants which are also placed below the pectoralis muscle, pectoral implant placement should not violate the lateral pectoral muscle border. (total muscular coverage)  Breast implants go beyond this muscle border to create a breast mound effect and are known as partial submuscular or dual plane implants.

If during the placement of a pectoral implant the lateral muscle border is violated or weakened, the implant will set lower than the muscle outline. Instead of creating an enhanced chest muscle effect the augmentation result can start to resemble more of a breast mound effect. This is known as bottoming out of the implant’s position. This can occur in pectoral implants just like it can occur in breast implants.

pectoral-implant-respositioning-surgery-intraop-dr-barry-eppley-indianapolisTreating the malpositioned or bottom out pectoral implant requires a procedure known as capsular plication or a reduction capsulotomy. In this procedure the bottom and/or side pocket of the implant is tightened up or lifted and closed with permanent sutures. In essence the lateral and lower border the pectoralis muscle is re-established. This is conformed before surgery by manually lifting the bottom of the implant up into the desired position.

pectoral-implant-capsular-plication-intraop-dr-barry-eppley-indianapolisRepositioning of the bottom out pectoral implant(s) can not be done through the same high axillary incisions by which they were placed. It requires a lower inframammary incisional approach to get the implants back up and secured into a better position…just like is done with repositioning breast implants in women.

custom-pectoral-implant-vs-standard-pectoral-implant-dr-barry-eppley-indianapolisIn some cases of pectoral implant repositioning, the opportunity for a change in implant implant style and size can also be done. The inframammary approach, with an incision no longer than 5 to 7cms, provides good access for implant removal and replacement.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Extra Large Custom Pectoral Implants

Friday, July 22nd, 2016

 

Background: Augmentation of the male chest is most commonly and successfully done by weight control and muscle hypertrophy and exercise. A more immediate and sustained effect that does not rely on strenuous exercise is that of pectoral implants. Such male chest augmentation devices have been around for decades and have a long track history of successful clinical outcomes. Unlike the female equivalent of breast implants, however, pectoral implants are solid devices that will never need to be replaced because of device failure. (rupture)

The styles of pectoral implants are basically either oblong or more rectangular in shape. Most men prefer the rectangular shape as it more effectively increases the fullness in the upper portion of the pectoralis muscle close to the clavicle. The rectangular shaped implant can be used either in a vertical or horizontal orientation. Its maximal volume is just under 300cc.

While these standard pectoral implants can be adequate for many cases, some men prefer a more profound chest augmentation. Or some men are simply bigger in size and weight and the standard sizes are inadequate for their aesthetic desires. In these cases custom pectoral implants have a definitive role.

Tiller Pec L XXL r3Case Study: This middle-aged male wanted a significant chest muscle enhancement. Given his large body frame (over 6’ 4” tall) and weight, all standard sized pectoral implants would have made very little change compared to his goals.  A pair of extra large custom pectoral implants were designed and made to exceed the dimensions of standard sized implants used by a considerable margin.. These custom implants were different in all dimension especially in thickness (5cm) and in total volume. (900cc)

Extra Large Custom Pectoral Imlpants intraop positioning Dr Barry Eppley IndianapolisUnder general anesthesia a 7 cm axillary incision was made in the anterior axillary skin crease. Dissection was carried under the outer border of the pectoralis muscle and a submuscular pocket created. Care was taken to not violate the attachments of the lateral border of the muscle. The extra large implants were inserted and positioned. A three layer closure was done over the exposed upper outer edge of the implants.

Extra Large Custom Pectoral Implant immediate intraop result below view Dr Barry Eppley IndianapolisExtra Large Custom Pectoral Implants intraop result right side view Dr Barry Eppley IndianapolisThe change in chest size was significant and symmetric. Interestingly the implants on the inside did not create an effect as large as one would anticipate when looking at them laying on the chest.

Extra large custom pectoral implants can be made and used when a significant chest size change is desired. It can be impressive that such a large implant can be inserted through a small axillary approach into the submuscular pocket.

Highlights:

1) Pectoral implants are the immediate, surgical and permanent method for chest muscle enhancement.

2) Standard implants are satisfactory for the vast majority of men seeking chest muscle enhancement.

3) Custom pectoral implants can be made in extra large sizes to address patient requests for extreme amounts of chest muscle augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Surgical Techniques in Pectoral Implants

Sunday, January 17th, 2016

 

Pectoral implants are the male equivalent of breast implants for women. The fundamental difference is that pectoral implants are a muscle enhancing procedure while breast implants are a non-muscular soft tissue (breast mound) enhancing procedure. These anatomic differences make for subtle but significant differences in the surgical technique in how the implants are placed.

Pectoral Implant incision Dr Barry Eppley IndianapolisPectoral Implant finger dissection Dr Barry Eppley IndianapolisPectoral implants are placed somewhat similarly as that of transaxillary breast augmentation. A high axillary skin incision is made that is about 6cms long in the skin crease just lateral to the edge of the pectoral muscle. Once through the skin blunt dissection with a finger is carried into the submuscular place superiorly towards the clavicle. Once the clavicle is reached the finger is turned downward sweeping across the top of the ribs.

Pectoral Implants instrument dissection Dr Barry Eppley IndianapolisA special instrument (Dingman-Agris dissector) is then inserted through the incision into the submuscular pocket created by the finger dissection. The instrument is used to make and reach the extent of the submuscular pocket. It is of critical importance that the lateral edge of the pectoral muscle attachments not be disrupted. (this is in contrast to that of making a breast implant pocket where the implant must go further to the side) The submuscular pocket is then washed out with saline until clear.

Pectoral Implant insertion technique Dr Barry Eppley IndianapolisPectoral Implant placement technique Dr Barry Eppley IndianapolisThe insertion of a pectoral implant requires that it be folded in half.  In so doing and in the insertion process, it is important that the implant does not get torn or its shape disrupted. This is an important feature of how the implant is made. This is why I prefer using Implantech’s PowerFlex pectoral implants. They are made with a soft durometer but have a more stout silicone layer on their outside. This provides some ‘toughness ‘ to the implant so it can be inserted through much smaller incisions than its width would suggest it could. Once inserted the implant will unfold itself and can be slide into position.

Pectoral Implants intraop result Dr Barry Eppley IndianapolisOnce the incisions are closed, most men will benefit by liposuction of the lateral pectoral triangle that lies from the outer edge of the pectoralis major muscle onto the chest wall.This helps define the margins of the edge of the pectoralis muscle by contrasting the increased convexity of the muscle prominence with the increased concavity of the side of the chest.

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.

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