Pectoral implants are the only effective surgical method of chest muscle augmentation. They are typically placed through a high axillary incision for direct access to the submuscular pocket between the pectoralis major and the pectoralis minor. The creation of the submuscular pocket is done using instruments through the axillary incision and is essentially done blind guided by external visualization and manual palpation.
Part of the success of pectoral implants is that the bilateral pockets that have been created are fairly similar. Since the implants are identical in shape and size the similarity of the pockets in which they reside will determine the symmetry of the result. But despite the surgeon’s best effort differences in the pockets can occur and pectoral implant asymmetry results. This asymmetry almost always occurs in the inferior-lateral pocket location as the superior and medial pocket borders can not be over extended due to the tight attachments of the origin of the pectoralis major muscle.
With an overextended lateral pocket the pectoral implant drops more to the side in which improvement can be clearly seen by pushing the implant back up manually. This can be done surgically by closing down the enlarged pocket by suture plication. This is a common technique used all the time in breast implants but the difference in pectoral implants is the lack of a convenient incisional access to do so. It is technically impossible to perform such capsule plications through a high axillary incision.
Thus a direct incision is needed at the location where the greatest push upward is needed. The incision is small and direction is right down to the implant capsule. The capsule is opened and the implant exposed. The implant is then pushed back up into position and permanent heavy braided sutures are placed to close down the enlarged pocket area between the capsule/lateral pectoral muscle and the capsule on the ribcage. Three to four sutures are all that can be placed through this small incision but is usually all that is needed.
The skin incision is then closed with resorbable sutures and lateral foam and a circumferential binder applied for postoperative compression.
While this does create a scar in a non-hidden location it is really the only way to perform capsular plication of a pectoral implant pocket in most cases.
Dr. Barry Eppley
World-Renowned Plastic Surgeon