Background: There are eleven (11) different muscle areas that can be aesthetically enhanced by implants in the body. (minus the face) In the upper body this includes the pectoral (chest), bicep and tricep (upper arm), deltoid (shoulder), brachioradialis (forearm) and trapezius. (upper back muscles) Of all of these muscle enhancement sites the trapezius is the most unique of them.
The trapezius muscle is a paired trapezoid-shaped superficial muscle of the upper back. Despite extending longitudinally from the back of the skull down to the lower thoracic vertebrae and out to the side to the scapula, it is most commonly recognized from the front view. This limited muscle area is what is seen to be increased in size by weight training and body builders although this represents just a small portion of the muscle’s surface area.
What makes the trapezius muscle unique from an implant augmentation standpoint are two features. First only a small portion of the muscle needed to be augmented to make a visual difference. (as seen primarily in the front view) Secondly it is not a gliding muscle so there is not a non-adherent connection between the enveloping fascia and the muscle, making subfascial implant placement difficult.
Case Study: This older male desired trapezius augmentation already having pectoral and bicep implants. (to be getting deltoid implants later) He was to to undergo combined tricep, trapezius and forearm implants.
Under general anesthesia and in the prone position 3 cm incisions were made in a posterior neck crease. Deep subcutaneous dissection was used to create the pocket out to the shoulder joint bump. Soft 18cm long x 6cm wide calf implants were carved down and placed in an inverted fashion into the pocket. (fuller part out to the sides and the thinner part at the neck) No drains were used with a resorbable suture closure.
Once the major swelling subsided his now enhanced upper trapezius prominence could be seen.
From the back view no implant edge show was yet evident.
There are outer features of augmenting the trapezius muscle that also make it unique from an implant standpoint. There are no standard preformed trapezius implants that are commercially available. Thus one has to either make them custom for each patient or use another body implant that has a somewhat similar shape. (e.g., calf implants) There is also different shapes to trapezius muscle augmentation that one patient may prefer over another. They can be divided into a linear augmentation effect or a non-linear augmentation effect. The non-linear effect is what is typically seen in body builders who have built up the muscle by exercise, hence more of ma body builder look. The linear look is usually for those men that want a more modest and less muscular look. Knowing the desired trapezius look will influence the choice of the implant and how it may need to be modified intraoperatively.
Key Points:
1) Augmentation of the trapezius muscle requires an implant placed in the suprafascial location.
2) Trap implants are done in the prone position intraoperatively.
3) There is a diverse shape to the enlarged trapeziums muscle which must be considered when choosing an implant shape/size.
Dr. Barry Eppley
World-Renowned Plastic Surgeon