Background:  One sign of masculinity is the size and shape of a man’s chest. This has been so since antiquity and is evidenced today from comic book characters to body building and muscle supplements. The one largest tissue component that gives a male chest its features is the pectoral muscles.

The pectoral muscle is a very large fan-shaped muscle that extends from an attachment from the upper arm bone to the clavicle and outer edge of the sternum across the chest area. It is a triangular-shaped muscle whose lower border, running from a line from the upper arm to the lower chest, creates a well-defined lower pectoral edge. The size of the muscle, primarily defined as its thickness, is what creates the pectoral outlines and amount of projection.

For men who want an immediate solution to increased pectoral size and definition, pectoral implant surgery can be done. This would be appropriate for those men who can not get the pectoral size they want despite exercise or for those men who simply do not have the time or desire to achieve it by exercise-induced muscular hypertrophy. Pectoral implants come in a variety of shapes and thicknesses to fit just about any man’s chest shape.

The placement of pectoral implants in men is very similar to female breast augmentation in many filled device. It is a solid silicone implant that is incredibly soft and flexible, very similar in feel to that of natural muscle. Like transaxillary breast augmentation, the implant is placed through an incision high up inside the armpit. The exact placement of a pectoral implant in relation to the muscle is also different. While breast implants release and go below the lower pectoral muscle border, it is extremely important that pectoral implants do not. The goal of pectoral implant placement is to keep it entirely in a submuscular location which will help to push the entire muscle forward as well as keep its natural muscular outline.

Case Study: This 46 year-old male wanted pectoral enlargement. He freely admitted that he had long wanted it but did not want to make the effort to try and achieve it by exercise. He had tried when he was younger but was never able to create much pectoral enlargement. His pectiral dimensions where 16cm width and 12cm in height at the mid-pectoral line.

Under general anesthesia, transaxillary incision of 4.5 cms were made high up inside his armpit starting at the edge of the pectoral muscle. A submuscular pocket was developed preserving the lower edge of the pectoral muscle border with instruments. Using oval style pectoral implants of 310cc volume with maximal projection of 3.5 cms, these were rolled and inserted into the pockets. The incisions were closed with dissolveable sutures and he was placed in a circumferential chest wrap. Surgery time was one hour and he was discharged to home after recovering for an additional hour.

His postoperative course was typical for pectoral augmentation with some significant pain the first day or two and moderate swelling. But by one week after surgery he was much more active and comfortable. He returned to work ten days after surgery but remained on lighter duty for a few additional weeks. He descibed full recovery as taking a full month after surgery.

Pectoral implants provide an immediate solution to make chest augmentation. It is really no different than women who have breast augmentation that is much more common. The implants are solid, however, and will never fail or need to be replaced unlike those used in breast augmentation. Proper pectoral implant size selection is important to make sure that the implant stays within the outlines of the pectoral muscles.

Case Highlights:

•         Development of the pectoral muscles in size and outline can be difficult for some men either failing to achieve their size or not having the time/committment to exercise enough.

•         Pectoral augmentation is done through an armpit incision using a very soft but solid silcione elastomer implant.

•         Recovery after pectoral implant augmentation takes about three weeks until one can return to all normal activities including working out.

Dr. Barry Eppley

Indianapolis, Indiana

Background:  Poland’s syndrome is a very well known set of congenital malformations involving one side of the chest and arm. The complete set of findings include a smaller hand with webbing and an underdeveloped sterno-clavicular portion of the pectoralis muscle. This results in a smaller chest on the affected side with a less developed nipple and muscle. It occurs five times more frequently on the right side and two or three times as often in males.

The key feature and often the one of greatest concern to a patient is the chest deformity. The distal end of the pectoralis major muscle that attaches to the lower end of the sternum is missing. This is technically known as aplasia of the sternal head of the pectoralis muscle. Regardless of the name, this appears as a smaller and asymmetric chest shape in men.

No amount of exercise will develop an asplastic pectoralis muscle to match the contralateral normal side. The muscle is simply smaller and making what exists bigger through weight training will not create enough muscle mass. Exercise-induced muscle hypertrophy does help but some form of reconstruction is necessary to get the best chest symmetry possible.

Case Study: This 33 year-old male presented for a right pectoral implant. He had always had a smaller chest on the right side as well as a deviated and lower positioned right shoulder. There was some slight skin webbing across the axilla and he had a small web between the third and fourth finger of his right hand. He had never been given the formal diagnosis of Poland’s syndrome.

Under general anesthesia, an incision was made high up inside the right armpit. Dissection was carried under the pectoralis muscle which was difficult as it was very fibrotic and adhered to the chest wall. The muscle could be felt to be short in length. Dissection was carried down below the edge of the muscle to a predetermined skin mark that matched the lower edge of the pectoralis muscle on the opposite side. A soft flexible silicone elastomer pectoral implant was used of a style 1 shape. Its maximal projection was 3 cms. After trying it in, it was cut down in size by about 1/3. It was then re-inserted and the incision closed. No drain was used.

His postoperative course was typical for any other pectoral implant surgery. He was sore and swollen but by three weeks after surgery was back to all normal activities. He resumed full weight training one month after surgery. His chest symmetry was much improved.

For mild to moderate chest asymmetries due to pectoralis muscle deformities, a traditional silicone elastomer pectoral implant can be very helpful. Adjustments to the size and shape of the implant are often needed to avoid creating a chest appearance that is bigger than the normal side.

Case Highlights:

1)      Poland’s syndrome causes underdevelopment of one side of the chest, shoulder and arm, including the pectoralis muscle.

2)      An increase in the size of the pectoralis muscle in Poland’s syndrome in men can be done with a pectoral implant.  

3)      A pectoral implant is inserted through a transaxillary incision under the pectoralis muscle. It  will usually have to be modified down in size for a more custom approach to the hypoplastic muscle.

Dr. Barry Eppley

Indianapolis, Indiana

A desireable male chest is usually defined by having well defined and fuller pectoralis muscles. For a body builder, model or anyone that does weightlifting to any serious degree, pectoral definition is the cornerstone upon which a great male body is built. Pectoral muscles due to their size and attachment to the arms is one of the easier muscles to build. Through the enlargement of both the major and minor divisions of the muscle, most men can usually develop adequate pectoralis fullness and thickness.

But developing the pectoralis muscle for some is not so easy. Whether it be one’s genetics or lack of time or commitment to the development process, a shortcut to achieve a better defined chest is appealing. Pectoral implants have been available for some time to those who are unable to  develop the desired thickness of their chest muscles.

While the concept of an implant in one’s chest may seem unnatural for a man, the subpectoral (under the muscle) location of the implant gives a fairly natural look. Being completely under the muscle (unlike a breast implant in a female in which half of the implant is beyond the lower border of the muscle), one’s pectoral muscle is pushed out so that is actually what you see and feel. For a man with poor or ill-defined pectoral muscle size, the implant can easily give better bulk. In the already muscular male, pectoral implants produce the best results since the muscle is already fairly developed. That is a key point…pectoral implants can only highlight what you already have. You can’t go from a completely flat chest to a chest that looks like a professional bodybuilder. That is not a realistic expectation from pectoral implants.

Like the breast implant in breast augmentation, the pectoral implant in male chest augmentation is key. Determining the correct shape and size of implant to be used is as important as the surgical technique in placing it. If the implant size is incorrect or the shape is wrong, the result of even the most technically perfect surgical procedure will not produce the best aesthetic result.

Pectoral implants are very soft and flexible solid silicone elastomers. This not only makes them soft and natural to feel but enables them to be folded onto themselves to be inserted through an incision in the armpit. While there are numerous manufacturers who offer different styles and sizes, there are some basic implant considerations. One style is that of the anatomic (oval or teardrop) shape which will provide a natural pectoral definition with moderate amounts of projection. The other main style is that of the square or non-oval shapes which provide a more square definition to the chest with projections closer to the sternum and the collarbone. Determining which style of pectoral implant is fairly easy by looking at the shape of the patient’s chest and where any existing muscle bulk currently exists. By far, the anatomic shape is the most commonly used. Furthermore, these implants are easily cut and modified during surgery.

Choosing the size of a pectoral implant is more difficult. Sizes are done in volumes that can range anywhere from 185cc up to just under 400ccs. But such volumes don’t really mean anything to a patient. Volume relates more to the surface area that the implant covers. While a large volume pectoral implant does add more overall volume to pectoral muscle size, a more  relevant concept that patient’s more easily understand is that of projection. Implant projections range anywhere from 2 to 3cms, or just around an inch. Understanding that even the biggest pectoral implant volume (380cc) gives a maximal projection of 3 cms can help one understand why the native thickness of one’s pectoral muscle is so important to what type of result can be  achieved with an implant.  

Some male patients have chest shape issues such as asymmetry or congenital and traumatic deformities that will not be best served by the shape and size of off-the-shelf implants. While some modifications can be easily done during surgery to shape an implant, custom implants are often better. These custom pectoral implants can now be made through the use of a moulage or mold kit. Manufacturers provide the kit which enables an elastic mold to be made of the patient’s chest from which an implant can be custom made.  These custom designed pectoral implants can help an abnormally-shaped chest by providing more projection or fullness to specific areas of the implant which can not be done by cutting down a stock implant.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis Indiana

Enlargement of the male chest is most commonly done through exercise and subsequent muscle hypertrophy. Strenuous physical exertion and protein supplements can build muscle, often times very impressively. Under ordinary circumstances, most people can create mild to moderate pectoral enlargement that they will find satisfactory. For those seeking substantial chest definition, chest enlargement in the shortest period of time, or if one suffers from developmental pectoral or sternal deformities, exercise alone will not produce a desired result.

Significant pectoral enlargement and definition can most rapidly and assuredly be achieved through an implant. While breast implants in women are far more commonly performed, pectoral implants for men are an equally satisfying procedure. Being essentially the same operation as that of breast augmentation (albeit with a different implant shape and texture), a well placed implant can create a subtle to dramatic change in one’s pectoral outline.

Pectoral implants are placed through an armpit (transaxillary) incision. Made larger than that used for a saline breast implant, the incision is usually about 6 to 8 cms long in the highest skin crease in the armpit. The incision needs to be longer than that for saline breast augmentation because the implant is inserted at its full size (this can not be altered) while a breast implant is deflated and inserted at a fraction of its functional size. The scars, while red for a time after surgery, usually heal quite well and are ultimately hidden within the armpit hair.

A pectoral implant is inserted under the pectoralis major muscle but above the smaller pectoralis minor muscle. This is a natural plane that is easily developed. The dissection should not be lower than the bottom edge of the muscle unlike the pocket that is developed for female breast implants. The goal is to increase the projection and definition of the existing pectoral muscle, not create a new outline or position for it. (in some developmental chest wall deformities this may be needed)

The pectoral implant itself is a solid silicone elastomer that is soft and flexible. Its flexibility is demonstrated but it being able to be folded unto itself to be inserted through the armpit incision. Its feels very much like a ‘gummy bear’ candy. Pectoral implants comes in several different styles (and different sizes within each style), an oval and a more rectangular shape. Which one is best can be determined by taking measurements of one’s pectoral muscle and an artistic sense of the patient’s final goal. As a general rule, rectangular implant is going to give more bulk and definition as there is more implant volume per size. But, like breast implants, the exiting size and shape of one’s chest has a major impact on how any style or size will look.

Because it is muscular manipulation, pectoral implant surgery will be sore after and it takes time to feel comfortable again. I do not use drains after surgery but some plastic surgeons do as this is perfectly fine. Fluid collections or seromas after surgery are not only possible but do occur. So limiting strenuous activity for 3 weeks after surgery is important. But I do want patients to be doing arm range of motion exercises within days after surgery, but just no weights.

Pectoral implants offer a rapid and reliable method for enhancing the male chest. Good results come from a limited intraoperative pocket dissection, good implant style and size selection, and refraining from strenuous physical activity for several weeks after surgery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Pectoral Etching and Liposculpture in Indianapolis

Contouring of the chest region by pectoral etching helps provide better definition to the pectoral muscles and the shape of the chest wall. Borrowing the concept from abdominal etching, in which the use of linear liposuction is used to define muscular edges and definitions, a similar technique can be applied to the chest with equally good results.

By selective removal of fat (liposculpture) from the side and lower borders of the pectoralis major muscle, the muscular appearance of the chest wall can be improved. This virilizes the chest contour while creating few visible scars. By sculpting the borders, and leaving fat over the main body of the muscle, the pectoral muscle bulk appears greater. This pectoral etching technique provides better shaping than simple gross fat removal in an even unsculpted manner across the chest wall.

Pectoral etching adds visible and palpable pectoral inscriptions to the chest wall. In a recent study published in Plastic and Reconstructive Surgery in December 2007, Dr. Ruiz-Razura and colleagues report treating over 200 patients over the past three years.with only a few minor complications. (small hematoma, irregular contour, too conservative of a result) Their experience has been that the results have been maintained, even in the face of weight gain and skin loosening with age. When pectoral etching is combined with abdominal etching, a more muscular-appearing torso is achieved. The procedure is becoming very popular in non-athletic males whose physique may not get sculpted even with regular strength training.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Pectoral Implants for Male Chest Enhancement in Indianapolis

The use of chest implants is more than just for women. More males than ever before are seeking a more rapid means to enhance their chest shape through implants. Men that seek chest implants, however, often do so for a different reason than women seeking breast implants. Women are after bigger chest size, men are after better chest shape with improved pectoral muscle definition. In some cases, men have a congenital deformity where one side of the chest is smaller and differently shaped than the other side. More commonly, their chest shape is quite flat and they have been unable, despite working out, to significantly improve the size of their pectoral muscles.

The use of pectoral implants is a very effective method of improving the shape of the male chest. Unlike breast implants, pectoral implants are made of a solid silicone rubber material. They are quite soft and very flexible. They come in multiple sizes in two basic implant shapes, one oblong style to accentuate the lower border of the pectoral muscle and another more box or square shape to increase the upper chest as well. Pectoral implants are placed through an extended incision in the armpit where it is easy to get under the muscle for implant placement and the scar is well hidden. The pectoral implant operation is fairly simple, takes about one hour to do, and is done as an outpatient. A compression chest garment is worn for 7 to 10 days after pectoral implants until it is comfortable to be without it. Normal activities, such as exercise, can resume in about 3 weeks after surgery.

I have not yet seen any significant complications after pectoral implants, which is very similar to what is seen after breast implants. The most common problem can be asymmetry, where despite even placement at the time of surgery, the healing process settles one implant differently in place than the other. Too much early activity, such as strenuous exercise, can cause fluid build-up (a.k.a., seroma) which will need to be drained. This is of particular concern in bodybuilders who have trouble taking time off from exercise. Despite these few potential risks, pectoral implants can be a very satisfying treatment for the male with poor chest definition.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis