Background: The deltoid muscle is the large muscle that forms the rounded contour of the shoulder. It essentially joins the upper extremity with the back and chest. While often perceived as just one large muscle, it really consists of three distinct muscle heads making up the front (anterior), middle (central) and back (posterior) regions of the muscle.
Several major body muscle areas, such as the pectoral, gluteal and gastrocnemius, can be augmented with implants to enhance their appearance. The shoulder or deltoid muscles are no exception. Men with more narrow shoulders may appear less muscular due to a smaller deltoid muscle. For the male who does regular but not vigorous exercise or weightlifting, it can be hard to effectively increase the muscle’s size or to maintain it even if it can be adequately increased. Other man just have naturally smaller body builds with rounded and ill-defined shoulders.
Making a more square or prominent shoulder can be done in a non-surgical fashion using external padding. Performed shoulder pads for men do exist or can be made from memory foam that is cut to the desired size with taper edges. While is effective in clothes it will require internal padding or implants to be effective out of clothes.
Case Study: This older male presented for deltoid implants after having worn performed shoulder pads for years. He finally tired of having to wear the inserts even though they were relatively inexpensive and easy to use. Over the years he had acquired a closet full of these preformed shoulder pads.
Custom deltoid implants were made based on patient measurements and were made slightly bigger in surface area than his performed shoulder pads. Rather than having a completely ovoid design, the upper portion of the implant was made slightly more square for an enhanced effect. The maximum thickness of the implant was in the central upper this and was 12 mms. The implants were made of an ultra soft solid silicone gel.
Under general anesthesia and through a skin incision at the posterior border of the muscle, a subfascial pockets developed anteriorly around the curve of the muscle’s outer surface according to external skin markings. Once dissected the implants were slipped into place and the fascia and skin closed.
Injection fat grafting was then done over the acromio-clavocular point area making sure to stay out of the implant pocket at the top of the shoulder. The outline of the implant on the skin was taped prior to placing ace wraps around the upper arm and shoulder.
Deltoid implants increase the lateral projection of the shoulders for an increased muscle size appearance. Greater squareness of the shoulders can also be achieved by additional fat grafting on the very top of the shoulders to create more of a horizontal augmentation to complement the more vertical effect of the implants.
Highlights:
1) Deltoids or shoulder widening implants are made custom for each patient as there are no such standard implants.
2) Shoulder implants are placed in a subfascial location from a posterior incisional approach.
3) Pocket dissection for the implant requires special instrumentation give the distance between the incision and the more interior curved pocket.
Dr. Barry Eppley
Indianapolis, Indiana