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.
A 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.
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.
Unlike 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.
Because 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.
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.
His 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.
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.
One 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.
Treating 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.
Repositioning 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.
In 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.
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.
Case 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)
Under 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.
The 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.
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.
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 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.
A 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.
The 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.
Once 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.
Unlike facial implants, the use of body implants (excluding breast implants) has a much shorter surgical history. While the use of facial implants dates back more than five decades in plastic surgery, body implants have been done for less than two decades and in numbers that are just a fraction of that of face or breast implants.
One type of body implant is that used for pectoral or chest enhancement. Pectoral implants are used for a variety of chest shape concerns such as aesthetic muscle enhancement or in the correction of congenital deformities such as Poland’s syndrome. They have a very successful history in plastic surgery of favorable patient outcomes with a low risk of complications. But there are numerous misconceptions about pectoral implants so let me dispel a few of them.
A Pectoral Implant Is Not The Same As A Breast Implant. A breast implant is a two part medical device that has an outer silicone shell (bag) which contains either saline or a silicone gel. They have a limited span and will not last forever in any patient. One day the bag will develop a tear and the failed implant will need replaced. Conversely, pectoral implants are made of a solid silicone material that can not fail, rupture or break apart. Thus pectoral implants are permanent medical devices that will never need to be replaced due to structural implant problems.
There have been a few cases across the U.S. where surgeons have made the inexplainable decision to use breast implants for male pectoral augmentation. While that would be appropriate for transgender (male to female) breast augmentation, only solid pectoral implants should be used for male chest enhancement.
A Pectoral Implant Is A Muscle Implant. What is unique about most body implants is that they are designed to do muscle augmentation and are really ‘muscle implants.’ They are usually shaped like the muscle they are designed to enhance. Although they are solid implants they are very soft and flexible and will essentially feel similar to the muscle they are designed to enhance. They are made of a low durometer silicone material which allows for tremendous flexibility without tearing or fracturing the implant.
Pectoral Implants Are Not Just For Body Builders. Many people have the misconception that a man gets pectoral implants because they want to look like a body builder. That is a very uncommon use for pectoral implants. They are far more frequently used in men who can not adequately develop sufficient pectoral size through exercise or who have chest deficiences/asymmetries due to a congenital or developmental anomaly. In other words they are used for men who are seeking to look more normal…not ‘supernormal’.
Pectoral Implants Are Available In A Variety Of Shapes and Sizes. Since the shape and size of men’s chests can be very different, it is no surprise that pectoral implants are not just ‘one size fits all’. The main shapes of pectoral implants are either oval or more rectangular based on the areas of desired chest enhancement. Sizes are a combination of length, width and height measurements and the volume in ccs of solid silicone contained therein. (somewhat similar to breast implants) Matching the implant size and shape to each individual man’s chest shape is one of the keys to a successful pectoral augmentation outcome.
Pectoral Implants Are Placed Through High Axillary Incisions. As part of a successful pectoral implant surgery, the incision to place the implant should be hidden. The only place to insert a pectoral implant is through an incision way up in the armpit or axillary region. While the incision will be slightly longer than that used for placing breast implants, incisions in the armpit usually heal very heal to the hair follicles and sweat glands that are present in the skin.
Background: The male chest is largely defined by the size and shape of the pectoralis muscle as well as the nipple-areolar complex. While chest asymmetry to some degree is common in many men, significant asymmetry is most commonluy caused by abnormal development. A variety of congenital male chest conditions exist including pectus excavatum and pectus carinatum as the most common occurring 1 to 400 to 1500 births.
Poland’s syndrome was described more than a hundred years ago is fairly rare occurring in more than 1 to 20,000 births. It really describes a spectrum of anterior chest wall deformities that can include the pectoralis major, pectoralis minor, serratus muscles as well as that of the ribs and even potentially extending to involve the arm and hand., ribs, and soft tissue. Deformities of the arm and hand may also be observed. It is far more common in men with a high ride sided occurrence. Poland’s syndrome presents in a wide ranging degree of expression from ver mild chest asymmetry with no arm involvement to the extreme of a flail chest and a short dysfunctional arm.
Reconstruction of many male Poland’s patients involves restoring/recreating the deficient pectoralis major muscle. This has been done historically by implants, muscle flaps and, more recently, fat injections. Each method has their own advantages and disadvantages as well as their own advocates. For smaller pectoral muscle deficiencies the choice of implants vs fat grafting are the logical (benefit vs risk) choices.
Case Study: This 30 year-old male was born with a mild manifestation of Poland’s syndrome that involved the left side of his chest. It was most evident by the loss of a well defined lower pectoralis major muscle border and smaller chest contour. A custom designed implant was made using a silicone elastomer molding technique and send for fabrication into a solid but flexible implant.
Under general anesthesia, the custom designed pectoral implant was placed through a transaxillary incision. After multiple trial fits it was determined that it was slightly too big. It was reduced down in size using scissors. Using a copy of the location of the lower border of the pectoralis major muscle the implant was inserted into a carefully made pocket using a long dingman dissecting instrument. The limits of the pocket defined the final implant’s location so that it could not migrate either inferiorly or superiorly.
When seen six months after surgery he had much improved chest asymmetry and no detection that there was any implant in place. It looked perfectly natural . The lower border of the pectoralis major muscle has been restored.
Custom designed pectoral implants can provide a good method of Poland’s chest reconstruction but they must be designed properly and placed into a carefully made pocket. There are multiple ways to create a custom designed pectoral implant but the simplest, and probably most effective, is to make a silicone elastomer mold on the actual patient. The muscle deficiency must be carefully determined through arm motion with an understanding that it is very easy to oversize it.
1) Male chest asymmetry is not that common and one of the origins of it is Poland’s syndrome.
2) Reconstruction of the male Poland’s chest is to create pectoralis muscle volume and a defined lower muscular border.
3) A custom designed pectoral implant is a useful reconstructive method in the male Poland’s chest and often needs to be smaller than one would initially think.
Background: Significant or extreme weight loss is defined as any amount over 75 lbs. or more. Such amounts of weight loss are most commonly caused by bariatric bypass, sleeve and gastric stapling procedures. Although there are some patients who do lose such large amounts of weight by their own diet and exercise efforts.
One of the well known effects of extreme amounts of weight loss is generalized tissue deflation and sagging skin. Depending on how much weight loss, gender and body location, there can be variable amounts of tissue thinning and loose skin. In general more sagging skin often occurs in women from the arms to the thighs than occurs in men. Part of this is due to better skin retractibility in men and having tissues that have never been previously stretched from pregnancies.
One body area where this gender difference in weight loss effects can be seen is the female breast and the male chest. In the female breast, which has an initial mound of tissue, volume deflation results in variable degrees of breast sagging over the inframammary fold. In the male chest, however, which may not have started out with a significant breast mound (although some men do have a large amount of breast tissue before the weight loss) the sagging of skin is usually less severe or may not be present at all.
Case Study: This 35 year-old male lost almost 90lbs through his own diet and exercise efforts. He had become so focused through this process that he became extremely fit and focused on optimal body shape and contour. While he was at a very good weight and was as lean as he wanted, he was not able to build up his chest as much as he liked. He also had some extra skin under his armpits that created an unaesthetic bulge.
Under general anesthesia, a transaxillary approach was initially done to place oval shaped 330cc silicone elastomer pectoral implants. They were placed without violating the lateral attachments of the pectoralis muscle. (unlike what is done in breast implants). The lateral pectoral triangle from the edge of the pectoralis muscle to the lateral chest wall was furthered defined by liposuction. Lastly, the skin roll by the armpits was excised and lifted using the same incision for the pectoral implants.
Recovery for pectoral implants is very similar as that for breast augmentation. It is a muscular recovery with the biggest issue being a delay to return to working out for ten to fourteen days.
Chest reshaping in men who have lost a lot of weight requires a combination of muscle augmentation, the creation of muscular outlines by liposuction and the removal of any redundant axillary skin folds. While the residual tissue effects from weight loss do not affect the male chest as much as the female breast, a pectoral implant alone can not create a complete chest reshaping.
1) Significant weight loss can cause a generalized chest ‘deflation’ with loose skin
2) Pectoral implants can serve as the foundation for chest reshaping efforts after weight loss.
3) Soft tissue contouring around pectoral implants is needed in the weight patient to optimize the improvement in muscle definition.
Short of metal implants used for fixation and repair in bone surgery, most implants used in plastic surgery are composed of a silicone-based material. It may have varying states of being a solid, (soft to more firm) but silicone-containing implants have long been recognized as one of, if not the most, biocompatible synthetic material in existence. The breast implant fiasco in the early 1990s created a vast patient scare and its negative connotations still reverberate today. This is despite the fact that silicone breast implants received complete vindication as being harmful and were re-introduced for clinical use again in 2006.
Because of its prevalence in implant surgery and various and often diverse opinions about its safety, it is time to review the basic science of silicone materials. To do so requires going to the periodic table and looking at the element called Silicon.
Silicon sits as a chemical element five vertical rows from the left and three horizontal rows from the top. It has the symbol Si and has an atomic weight of 14. It is what is called a tetravalent metalloid, which sounds like it is really a metal, although the term means that it has properties of both metals and non-metals. Joining Silicon as a metalloid are some familiar names from the very friendly Carbon (the basis of all organic life) to the very poisonous Arsenic. It is the second most common element available in the earth’s crust after oxygen, appearing in dust and sands usually in the form of silicon dioxide. (silica) It does not exist much in its purest form, but its use in that regard impacts all modern technologies as it serves as the basis of semiconductor electronics and integrated circuits.
Silicon has long served as the backbone for silicon-based polymers known as silicones. One should not confuse, however, Silicon and Silicone. The polymer Silicone does contain Silicon but it is put together with other elements such as oxygen and hydrogen which give it very different physical and chemical properties than elemental Silicon. These formulations create common products with a wide range of physical forms (soft to hard) such as silicone oils, rubber, caulk and a diverse number of medical implants. Silicone polymers have a large number of very favorable properties as an implanted material including remarkable stability (does not change over a temperature range of -100 to 250 degrees C), does not absorb water or other fluids, has little chemical reactivity, little known toxicity and does not support bacterial growth. Thus it is a structurally stable polymeric material that is not likely to degrade in any way over a patient’s lifetime.
The biocompatibility of a long-term implantable medical device refers to its ability to perform its intended function without creating any undesirable local or generalized effects. A silicone polymer fulfills that role well and, when combined with the wide availability and low cost of its base material, it is no wonder that most non-metal medical implants are made of some or all of it. Its easy moldability makes it able to be molded into almost any shape or size such as silicone gel breast implant, a soft solid pectoral or buttock implant and a soft but more firm facial implant.
But besides its unique physical properties when made into a polymer, is there anything else that makes it so biocompatible? It probably does not hurt that its closest vertical neighbor is Carbon. By its electronic composition, Carbon and Silicon are closely related event though they are distinct elements that form distinct compounds. But being next to the element that is responsible for all life on earth probably does not hurt how that life sees it.
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.