Pectoral implants are the male equivalent of breast implants for women. While done far less frequently, as men can build their pectoral muscles by exercise, they are very effective at enhancing the size of the pectoral muscle through placement behind it. They are actually done more often in men that workout than in men who don’t contrary to popular perception.
Unlike breast implants, the only aesthetically acceptable incision for pectoral implant insertion is through the axilla. A high transaxillary incision is used as, it not only keeps the scar off the chest wall, but is the shortest distance to the submuscular space under the pectoralis major muscle. At this point close to the arm the pectorals major muscle is most widely separated from the pectorals minor muscle. This allows for the easiest entrance to the submuscular space without having to disrupt any of the lateral pectoral muscle attachments except right next to the axilla. This ability alone is paramount as this is the key difference in pocket creation between pectoral implants in men and breast implants in women.
The size of the transaxillary incision for pectoral implants is larger than when used for the insertion of breast implants. It will usually be about 5 cms for most standard pectoral implant sizes. But as more and more custom pectoral implants are being used, their larger sizes makes keeping the incision a reasonable length more difficult. This is where borrowing a concept from breast implants is useful, the funnel insertion technique.
The well known funnel device allows a soft gel-filled breast implant to be inserted through a small incision by controlling its deformation through uniform compression out a smaller end hole than the diameter of the implant. This concept works equally well for pectoral implants. While a pectoral implant is more solid than a gel-filled breast implant it works equally well. The pectoral implant is folded onto itself and placed in the funnel.
By inserting the end of the funnel under the pectorals major muscle lateral border, it is squeezed through the incision and into the sub muscular space.
Once into the pocket it is necessary to manually unfold and position the implant. Since most pectoral implants do not have a completely symmetric shape their orientation is important in the pocket to achieve the desired external effect. (this is unlike round breast implants whose orientation is irrelevant) The funnel insertion technique for pectoral implants not only keeps the axillary incision size not unduly long but also prevents potential tearing of the soft durometer silicone material.
Dr. Barry Eppley
Indianapolis, Indiana