Can Pectoral Implants Be Placed In A Dual Plane Submuscular-Subcutaneous Pocket?

Q: Dr. Eppley, I have read your article about pec implants below and I am a bit confused.You say that male pectoral implants are placed in a  completely submuscular pocket whereas breast implants are placed in a partial submuscular pocket

What does you think about placing male pec implants in a partial submuscular pocket- dual plane with only the lower part of the pec implant sub-fascia instead of sub-muscular. 

Surely this would give a more natural look when the man raises his arms above his head- see the attached photo of pec implants vs real pecs? 

As with a completely submuscular pocket when the man raises his arms, the muscles raise but the implants do not they just sit there. 

A: It is important to understand why there are two pocket differences between pectoral implants and breast implants. The goal of breast implants is to create a soft tissue mound onto which the nipples are largely centered as much as possible on this created mound. This is why breast implants have to have a dual plane pocket creation, if a submuscular pocket is used, as the breast mound is not really muscular based. (the implant just happens to be partially under the muscle…which is also why it could also be above the musce as well) In essence the dual plane is necessay for a breast mound effect.

In contrast the goal of pectoral implants in the male is to create muscle enhancement/enlargement only. If the lateral pectoral line is violated in the creating the submuscular pocket more of a mound effect will be created which is an unnatural male chest appearance. 

When pectoral implants are placed in the proper pocket and not oversized they will not bulge out to the sides when one raises their arms and will usually move up with the muscle.The raised arm pectoral implant patient picture you are showing illustrates pocket violation beyond the lateral muscle border…which would also be evident when his arms are not raised as well.

Dr. Barry Eppley

Indianapolis, Indiana