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Background: Pectoral implants are the definitive male chest augmentation method. While fat injections may have a role in some minor chest augmentations implants are required for major chest enhancements. For the vast majority of men the use of standard pectoral implant sizes are adequate. Even for the patient seeking a very robust augmentation the PowerFlex Plus implant at 596ccs is going to be sufficient in most cases.

But for those few men seeking an extra large (XL) pectoral muscle augmentation and, if they are not small in stature or body frame an implant bigger than the PowerFlex Plus may be needed.  Such XL pectoral implants have to be custom made. The dimensions of those implants follow the basic footprint of the PowerFlex Plus but will have some dimensional increases in height, length and volume based on patient measurements.

One key element in XL pectoral implants is placement. One can design it but also it has to be placed for a successful outcome. Using a high axillary incisional approach introduction into the created submuscular space is the challenge. 

Case Study: This muscular male desired pectoral implants but wanted them to be sizable to make a significant difference. In that regard and using external pectoralis major muscle measurements an XL pectoral implant design was done with a volume of 850ccs and a projection of 4cms.

Under general anesthesia and through high 9cm long axillary incisions the sub muscular pocket was developed with instruments. The XL pectoral implants were opened and placed on the chest for sizing and the perception was that they were too wide.

The implants were reduced in width along the medial border with tapering into the superior and inferior areas. It is important to keep the medial border blunt and square shaped to help create visible edging/fullness along the sternal border.

When placed back on the patient externally a better implant fit was seen.

The implants were inserted using a funnel device through the high axillary incisions. Without such a device it would be hard if not impossible to get it through the incision. The axillary incisions were closed in layers with dissolvable sutures.

The intraoperative results showed the appreciable change in his chest as one would expect with 850cc implants.

When see the next day standing up the size increase of his chest was apparent. Bruising around the axillary incision sites is normal right after this surgery.


  1. Larger XL pectoral implant sizes beyond the PowerFlex Plus must be custom made.
  2. XL pectoral implants benefit by a funnel insertion technique rather than a non-device rolled placement method.
  3. The insertion of XL pectoral implants may cause some temporary nerve symptoms down into the hand from the stretch of a high axillary incisional location.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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