Q: Dr. Eppley, I am getting closer to making a decision about extra large pectoral implants. I currently have Implantech’s Power Flex Pectoral Implants. (ACPI-4, 17.6 x 13.4 x 3.2cms) I am looking for something much larger, particularly in projection…hopefully at least double or much larger with greater upper fullness and deeper separation/cleavage. I know my pecs will be out of proportion to the rest of my body but that is OK. ou sid I could get pectoral implants as large as possible that would fit in the tissue pocket. How would you be able to judge their maximum size. Didn’t you say you had used custom implants as big as 6.5 cms projection? Thank you so much for your kind attention to this matter.
A: When designing custom pectoral implants, several considerations go into considering their dimensions based on the restrictions of the submuscular implant pocket. First and foremost you have indwelling implants which have created a solid surrounding capsule. Unlike submuscular breast implants, the capsule of pectoral implants is harder to release much because of the limited access from the remote axillary incision from which the implants were initially inserted. The one area that most needs to be released is the sternal or medial edge of the pocket as well as the superior edge of the pocket since this is where you need the most expansion with new pectoral implants. Because you have the Powerflex pectoral implants (ACPI) that are more oblong rather than rectangular (PowerFlex II, ACPI2), your greatest area of ‘aesthetic’ deficiency is closer to the sternum. Any new pectoral implants must have a shape that is more like the PowerFlex II rather than the PowerFlex I that you have now.
Changing the height and width of your indwelling pectoral implants to 19 cms x 14.5 cms would be what I would advice. Any increase in pectoral implant surface area is going to come in the sternal side. Unlike the height and width of the existing pocket the ability to stretch the projection is more generous. Thus doubling their projection should not be a problem from a tissue stretch standpoint.
The only issue that bears consideration, and a possible limiting factor, is the insertion process of large custom pectoral implants. Pectoral implants are inserted through an axillary incision and are done so because they are folded onto themselves. The thicker the implant becomes the harder it is to roll it (fold in half) for insertion. This is why in very large pectoral implants the concept of double stacking implants rather than one single large implant is often considered.
Dr. Barry Eppley