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Dr. Barry Eppley

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Archive for the ‘pectoral implants’ Category

Five Facts About Pectoral Implants

Wednesday, July 29th, 2015

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.

Pectoral Muscle ImplantsA 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 Implant results front view Dr Barry Eppley IndianapolisPectoral Implants result oblique view Dr Barry Eppley IndianapolisPectoral 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 implant styles Dr Barry Eppley IndianapolisPectoral 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.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Pectoral Implant in Poland’s Syndrome

Thursday, July 2nd, 2015


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 SyndromePoland’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.

custom pectoral implant Dr Barry Eppley IndianapolisUnder 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.

Left Custom Pectoral Implant Poland's Syndrome Dr Barry Eppley IndianapolisWhen 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.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Male Chest Reshaping After Weight Loss

Sunday, July 6th, 2014


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.

Pectoral Implants after Weight Loss result front view Dr Barry Eppley IndianapolisPectoral Implants after Weight Loss result oblique view Dr Barry Eppely IndianapolisUnder 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.

Pectoral Implants after Weight Loss Dr Barry Eppley IndianapolisRecovery 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.

Case Highlights:

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.

Dr. Barry Eppley

Indianapolis, Indiana

The Biocompatibility of Silicone Polymer Implants in Plastic Surgery

Thursday, May 1st, 2014


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.

Periodic Table of Elements Dr Barry Eppley IndianapolisBecause 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 elementSilicon 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.

Silicone Polymers in Plastic Surgery Dr Barry Eppley IndianapolisSilicon 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

Indianapolis, Indiana

The Uniqueness of Male Plastic Surgery – Body Procedures

Thursday, June 13th, 2013


When it comes to plastic surgery, just like many other areas in life, men are different than women. Not only are their faces and bodies not the same, but their attitudes and expectations about plastic surgery are also different. Having treated a fair number of men over the years in my Indianapolis plastic surgery practice, I have made a number of observations on these gender differences.

It is true that the number of men, particularly younger men, are making up an increasing percentage of the total plastic surgery population. While the number of men having actual surgery or in-office injectable and skin care treatments will always be substantially less than women, men are noteworthy in that their procedures are either unique or require modifications. Numerous cosmetic procedures are not only uniquely different in men, but some of them are exclusive to men.

Enhancement of the male chest is an increasingly popular male plastic surgery procedure.  Chest issues are very different from that of the female breast. While women have surgery for small, poorly shaped or asymmetric breasts, men consider surgery because their chest appearance is not masculine enough due to gynecomastia, prominent nipples or lack of pectoral muscle size and definition. Gynecomastia reduction surgery is vastly different than female breast reduction surgery. Lack of visible scarring in a man takes on primary importance and the use of liposuction tissue extraction subsequently takes on greater importance. Prominent nipples, which occurs far more frequently in men than women, can have a very negative psychological effect for some men. Having them be obscure in a tight shirt is a common goal of all ages of men and this nipple reduction procedure can be accomplished as an office procedure under local anesthesia

Male chest enlargement is done by soft solid silicone implants that have to stay within the  lower and lateral borders of the pectoralis muscle. Female breast augmentation is done with non-solid filler materials in a shell (bag) that must be often be placed beyond the lower border of the muscle to get the proper shaping effect.

When it comes to body implants, the shape objectives between men and women are different. Men undergo have body enhancements, such as the chest, arms or calfs) to create increased muscle size and definition. Women have body implants of the breasts and buttock to create more shapely soft tissue curves which are non-muscular in structure.

The distribution of fat in men is uniquely different from women. Men have liposuction exclusively in the stomach and love handle areas. While women have liposuction in the same areas they have a broader expanse of potential fat collections which leads to aspirated fat removal also being done in the extremities as well as the trunk areas of the back, hips and buttocks.

Excess and loose body skin occurs more selectively in men than women. Because of pregnancies and weight loss thereafter, women frequently require tummy tucks. Men only need such excisional body contouring surgeries after extreme amounts of weight loss. (greater than 75 to 100 lbs) Those skin removal needs are almost exclusively limited to the abdomen (tummy tucks) and chest and almost never in the extremities.

Plastic surgery for men has its own unique requirements both in the type of surgeries and the demeanor of the patients. One should not assume that every plastic surgeon or plastic surgery practice is equally adept about meeting the needs of the male patient. Just like breast reconstruction for women or body contouring after massive weight loss, the male patient presents unique challenges for a satisfying surgical outcome.

Dr. Barry Eppley

Indianapolis, Indiana

Contemporary Body Implant Augmentation Surgery

Sunday, May 26th, 2013


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

Indianapolis, Indiana

Postoperative Instructions for Pectoral Implants

Monday, April 1st, 2013


Male chest enlargement by soft solid pectoral implants is done by placing them under the pectoralis major muscle. The implant is placed so that it stays above the lower muscle border, creating a larger pectoralis muscle bulge.

These are the typical postoperative instructions to follow after having had pectoral implant surgery.

1. Pectoral implants in men, similarly to breast implants in women, are associated with a moderate amount of pain in the first few days after surgery.  Usually narcotic pain medications are needed and you should them as prescribed. In a few days, you may switch to Tylenol or Ibuprofen or alternate between doses with the narcotic medication.

2.  There will be a circumferential chest wrap placed right after surgery. This is in place for comfort only and does not play a role in maintaining the position of the implants. You may take it on and off based on your comfort. Most patients feel more comfortable wearing fairly continuously for the first week after surgery.

3.  The sutures in the armpit incisions are dissolveable and do not need to be removed. You may apply antibiotic ointment to the armpit incisions twice a day for the first week after surgery.

4. Bruising may develop on the chest a few days after surgery which is perfectly normal.

5. You may shower and get your chest and armpits wet. There is no harm in cleaning them with soap and water.

6. Your armpits will feel stiff and sore after surgery and your arms more so on raising them. A faster recovery will occur if you begin raising your arms up to the level of your shoulders in the first day or two after surgery. Thereafter, practice raising your arms above your head. These arm range of motion exercises will help the injured pectoralis muscle feel less stiff sooner.

7. You may wear any type of shirt or garment, including one that has to pull over your head to get it on or off.

8. There are no restrictions on normal daily activities after the surgery. You may do light exercise anytime afterwards that you feel comfortable. But no strenuous exercise of the chest muscles for three weeks after surgery.

9.   You may drive within several days after the procedure, provided you are off pain medication and can react normally to driving conditions.

10.  If any redness, tenderness, or drainage develops on the chest or from the armpit incisions after the first week of surgery, call Dr. Eppley and have your pharmacy number ready.

Consent for Plastic Surgery: Pectoral Implants

Sunday, March 31st, 2013


Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the pectoral implant chest augmentation procedure. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all, of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.


There are no alternatives to augmentation of the male chest other than using an implant.


The goal of pectoral implants is to increase the size of the male chest by creating more pectoral volume and definition.


The limitations to pectoral augmentation are the dimensions of the patient’s chest and what size pectoral implant can inserted.


Expected outcomes include the following: temporary swelling and bruising of the chest wall, a temporary firmness/hardness of the chest, mild to moderate discomfort of the chest wall and temporary redness of the armpit incision line/scar. It may four to six weeks before the final shape and appearance of the chest is seen.


Complications may include bleeding, infection, dehiscence of the incisional closure (part or complete separation), prominent or noticeable armpit scars, chest asymmetry, and too big or too small a chest size result.


How the implanted site heals and the occurrence of complications can influence the final shape and appearance of the chest. Should complications or the desire to enhance the result further by additional surgery be needed, this will generate additional costs.

Chest Enhancement in Men with Pectoral Implants

Saturday, September 15th, 2012


Changing the chest of women is a very commonly done plastic surgery procedure, with nearly 350,000 women having the procedure last year in the U.S. Adding up all the women who have had breast augmentation over the past 20 years, it is estimated that about 1 in 7 women between the ages of 21 and 45 now have breast implants. Despite this tremendous chest changing that goes on in women, men do far less of it.

The equivalent of breast augmentation in men is the use of pectoral implants. There are no quoted estimates of the number of pectoral augmentations that are done per year in the U.S.. But it would be fair to say that for every 100 breast augmentations that are done, maybe one pectoral augmentation is done. This low rate is understandable as men have the ability, often times requiring extraordinary effort but possible nonetheless, to make the pectoral muscles bigger and more defined. No amount of exercise in a woman will make their breasts enlarge.

But there are men who simply can not build their pectoral muscles adequately through the natural route. Either through lack of effort, insufficient time or the anatomy and genetics of their chest shape and muscle size, they just can not build up their chest. I have even seen some men who have done well with their biceps and shoulder girdle muscle development but their pectoral muscles lag behind. They have a disporportionate chest shape.

Whatever the reason, the stories I hear are the same for why men explain their desire for surgical chest enhancement. Embarrassment to take their shorts off at the gym, at the pool, or in sports are the most common self-image issues. A flat chest with little pectoral definition and minimal pectoral margins is what you see. It is very uncommon to see a bodybuilder who merely wants to ‘cheat’ to an even larger pectoral muscle profile.

Like a breast implant, a pectoral implant is designed to enhance the natural chest muscle anatomy that one has. It increases the projection of the pectoral muscle and better defines its lateral margin known as the pectoral line. The pectoral muscle is a large fan-shaped muscle that occupies much of the chest and runs from the sternum  to the upper arm. This large muscle and its position on the chest wall  provides plenty of muscular coverage of the implant, unlike a breast implant which sits lower and often has only the upper half covered by the pectoral muscle.  With 100% muscle coverage, pectoral implants look perfectly natural.

There are other features that differentiate a pectoral implant from a breast implant. A breast implant is essentially a plastic bag that contains a filler material, either saline or silicone gel. They have a wide range of sizes in volumes from 150cc to 800cc. Conversely, pectoral implants are a solid (but incredibly squishy) implant whose sizes are much smaller, more in the ranges of 150cc up to around 350cc. Because they are a non-liquid implant they can never rupture, deflate or otherwise fail, once placed they are lifelong devices that will never need to be replaced due to a change in size or shape.

While pectoral implants are placed in the identical manner as the transaxillary saline implant approach, it is critical that they are not positioned on the chest wall like breast implants. Breast implants are positioned well below the lower edge of the pectoral muscle to create the lower pole shape of the breast. Conversely, pectoral implants are placed only down to the level of the lower border of the muscle…and never below.  They are actually positioned just above the nipple level. This will avoid the creation of ‘man boobs’. There are numerous stories of inexperienced surgeons with misadventures performing pectoral enhancement using breast implants and placing them too low.

Pectoral implants is gaining in popularity in men but will always lag far behind that of breast augmentation. But men should now that pectoral enhancement is as easily done as breast implants and are just as successful.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Pectoral Implants in Men

Tuesday, May 1st, 2012

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

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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