Q: Dr. Eppley, I am interested in deltoid implants. I was involved in a car accident many years ago which resulted in nerve damage to my left shoulder and caused complete atrophy to my deltoid muscles. I’ve been told that muscle replacement isn’t an option. I was told about the possibility of implants to surround the shoulder to at least give a more natural appearance. I would like more info as to if this is a possibility for me and an estimated cost.
A: Loss of deltoid muscle mass after nerve damage is very common. Since muscle transplants are not an option for the shoulder area, shoulder augmentation can only be done by either fat injections or deltoid implants. Fat injections are always an option for soft tissue augmentation although how much fat will survive and persist is always their potential downside. Deltoids implants made from a very soft solid silicone material offers assured volume retention but comes with uncommon but potential risk of infection.
The one issue with deltoid implants in cases of shoulder atrophy is how well the existing size of available implants may match the defect. Fortunately silicone body implants are very shapeable during surgery so they usually can be adapted to just about any size soft tissue defect.
The cost of a single one-sided deltoid implant would be in the range of $4,000.
Dr. Barry Eppley
Q: Dr. Eppley I would like to get deltoid implants, I’m a fairly tall at 6’1 but my shoulders are lacking. I have a narrow frame and would like silicone implants to widen my shoulders by 6 cm all together. I saw where a doctor from South Korea does deltoid implants by placing an incision under the armpit and uses silicone implants over the shoulders to reshape them and widen them. I would like to do 3 cm on each side like that surgeon does. I want to maximize my shoulders as much as possible while not over doing it. I would like to see if my clavicle growth plates have fused though before I get the implants to make sure I still have some growing room, thank you and hopefully you get back to me.
A: Deltoid implants are indeed placed through a posterior axillary incision. The implants are placed under the fascia up over the central region of the deltoid muscle. As you may know there are no off-the-shelf preformed deltoid implants that are commercially available in the U.S. due to low patient demand. What I use are Implantech’s silicone contoured carving blocks Style 3. Their greatest thickness are 2.1 cms. While a 3 cms deltoid implant can be made by them that is going to raise the cost of the implants by a significant amount. You will have to decide if the extra 9mms is worth the additional cost.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in some type of shoulder implants. I want to correct my body shape. All of the doctors I have seen suggest liposuction from belly and then inject that fat to shoulder areas but I think this is temporary solution. I dream something like silicone implants which are created custom for me. Please check my before and after photos I made it on an app.
A: What you seek for shoulder implants does exist and they are known as deltoid implants. Shoulder widening surgery can be done using preformed body implants or they can be custom made from a low durometer (very soft) solid silicone material. They are inserted from an incision at the back end of the armpit skin crease. Since there are no performed or standard deltoid implants, preformed calf implants are often used for the deltoid area as they have a long cylindrical shape to cover the central deltoid muscle. Custom shoulder implants can also be made from measurements on the patient baed on their length and width of the central deltoid muscle. Shoulder implant surgery is a procedure that takes about 90 minutes to perform under general anesthesia.
Dr. Barry Eppley
Q: Dr. Eppley, I have extremely narrow clavicles which have caused years of insecurity. I’m very interested in the deltoid implant surgery that you offer. I think I read that the maximum amount that you can add to each shoulder in width is 1.5cm. Is this figure correct and does it apply to both the method of silicone implant as well as the fat grafting technique?
A: Deltoid augmentation (aka deltoid muscle augmentation) can be done by either fat injections or actual deltoid implants. If you have adequate fat, fat injections would be preferred since they are the most natural and are scarless to perform. While not all the fat will survive, fat injections would always be the first choice. If one does not have enough fat than only an implant can be used. This is placed through an incision in the skin crease at the back of the axilla (armpit) and the implant is placed in a subfascial location over the central segment of the deltoid muscle.
Both deltoid augmentation approaches take about the same amount of time in surgery and both have about the same recovery. Neither deltoid augmentation technique will create a full 1.5 cm per side, close but not always.
Dr. Barry Eppley
Q: Dr. Eppley, You said that there is no deltoid implants but I found on internet that there is. I know about people get implants to their arms and belly to have muscles and six packs. so what kind of implants is it and can it be used for implants for the deltoid? o beside fat transfer/fat implants to the deltoid, is there any implants for the deltoid? Thank you.
A: What I said was that there are no preformed off-the-shelf deltoid implants that are made specifically for the deltoid/shoulder area. This is the same for other arm implants as well such as the biceps and triceps. The only body implants besides breasts that are commerically made are for pectoral, buttock and calf implants. It is unlikely that other body implants will be commercially made in the near future given their low demand. That does not mean that deltoid, bicep or tricep implants are not done as they are and I have done them as well. What is used for all arm and shoulder implants are the different sizes for calf implants. They are soft long and oblong and usually the small or medium size works well for the deltoid area. There soft silicone elastomer helps simulate muscle tissue which they are designed to augment.
Dr. Barry Eppley
Q: Dr. Eppley, I’m very interested in deltoid implants. I have a very narrow biacromial width and an ectomorphic body type. Tendonitis in the wrists for years has lead me to be unable to engage in hypertrophy training with free weights so I’m looking for an alternative solution to help overcome the insecurity that comes from having narrow shoulders. How much width can be added onto the shoulders and how soon would I be able to have the surgery.
A: When considering deltoid implants, it is important to know the exact location that the deltoid muscle needs to augmented. While the deltoid muscle forms the rounded contour of the shoulder, it really as three distinct sets of fibers or heads. The front head extends from the lateral third of the collar bone over the front part of the shoulder. The lateral head arises from the acromion process and covers the middle portion of the shoulder. The posterior head extends from the spine of the scapula and covers the back part of the shoulder/upper arm. While all three heads can be independently augmented, most patients are interested in the lateral head as this creates the greatest shoulder width. Incision location is best done at the back-shoulder junction and the implant placed in a subfascial location.
There are no truly preformed deltoid implants although they can be custom made based on the patient’s measurements. As an alternative, calf implants can be used as they are preformed and the medium size can add up to 1.5 cms in width per side and increase the muscle mass by over 100 grams of muscle volume.
Dr. Barry Eppley
Q: Dr. Eppley, my clavicles on both sides stick up. Have you dealt with this surgery before – do you recommend anything (would deltoid implants resolve this)? I don’t want huge shoulders, just bones not so prevalent and I don’t want scars. Appreciate any feedback.
A: I have seen and treated prominent clavicles before and they are not rare. From an anatomical standpoint, the clavicle or collarbone is the only long bone in the body that lies horizontally as it connects the medial sternum to the lateral scapula. The knob at the acromial end of the bone can be felt in anyone but in some people this bony bump is very prominent as a bulge underneath the skin on top of the shoulder. This occurs due to either more bone in some people or less surrounding fat in others.
Cosmetic camouflage can be done by bony reduction by burring but this creates a scar which you have eliminated as an option. Deltoid implants are not appropriate for camouflage as this type of implant fits over the larger muscle belly of the deltoid which is more to the side of the shoulder. The only scarless treatment option would be injectable fat grafting. Since a thin fat layer is one reason why a prominent clavicular knob is seen, fat grafting around the knob and out into the deltoid muscle belly provides the best treatment option. While fat graft survival is unpredictable and survives least in areas of thin fat with tight overlying skin, it is the one true scarless camouflage method. What may be helpful is deltoid augmentation by fat grafting not implants.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in getting deltoid implants. I am a 36 years old male and I have very short clavicles and a larger than average head to make my shoulders appear even more narrow. I have read a response to a deltoid implant question it made me come up with a few questions.
1. The response stated that the implants can be place in a intramuscular location. Does that apply to an implant for both lateral and posterior deltoid heads? If not, what type of deltoid implant can be placed in the muscle?
2. How much actual width could be added using the largest implant possible without effecting practical functions (such as lifting the arms sideways)? I attached a picture of my narrow shoulder along with a photo-reference of a look I’m going for. I’ve provided of a picture of the look I’m trying to achieve with surgery. The red area is what would be the ideal mass added with an implant. Would this be possible?
A: When it comes to deltoid implants, an understanding of the anatomy is important when considering implant placement. The deltoid muscle is a broad muscle that creates the rounded contour of the shoulder. While it technically has three sections or muscle bellies (anterior, central and posterior), it is best to surgically think if it as single muscle belly as they are difficult to separate. The muscle is also enveloped by a fascial lining that is most manifest on its outer surface. Thus implants can be placed either submuscular (under the muscle) or subfascial. (above the muscle but under the fascia)
When considering where to place a deltoid implant, one has to take into consideration the movement of the muscle and the arm. As the arm lifts away from the body, the deltoid muscle contracts and becomes shorter. There is the risk, therefore, that a submuscular implant placed directly under the central belly of the muscle could interfere with arm motion. This would be less true for a very small implant or one that is placed closer to the front or back edge of muscle, but this then would not have much of a visible effect as you desire. This makes the subfascial location preferred in most cases.
Lastly there is the issue of incision location to place a deltoid implant. This is almost always best done on the back side of the arm where it meeds the trunk, keeping any scarring in the least visible location.
Your photo reference indicates a result that probably can not be achieved. Maybe half to three-quarters of that amount of shoulder augmentation is more realistic. Think of adding about 1 to 1.5cms width per side.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in deltoid implants. I am a 25 year-old male who has done bodybuilding for the past two years with great results. This is with the exception of my deltoid muscles, which are one of the most important and prominent muscles on a male body. My dad has also weak shoulder muscles so I think it’s genetics.
Now my questions:
1. How are the (silicone ?) implants placed and where exactly, so that the most obvious effect in width is achieved ? Are they placed into the muscles or above, because one should not feel the material when one touch the shoulders if possible.
2. How thick are they? How much shoulder width can be added with the implants ?
3. What are the risks during and after such a surgery?
4. Is the result permanent?
1) They are silicone implants and are placed either subfascial or intramuscular, depending on which head of the deltoid is being augmented. Of the three heads of the deltoid, the most commonly augmented are the lateral and posterior heads with the implant placed between them. This also creates the greatest amount of width augmentation. It would be helpful to see exactly by pictures which areas of the deltoid you want augmented.
2) Since there are no real deltoid implants commercially made, I use calf implants which have three sizes (volumes 70 to 170ccs) with up to 2 cm of thickness per implant.
3) The risks of surgery are a permanent scar, infection, undercorrection/overcorrection, and implant malposition. (which are the standard risks of any implant-related surgery)
4) The implants will never degrade or breakdown and thus add permanent muscle augmentation.
Dr. Barry Eppley
Q: Dr. Eppley, I have narrow shoulders i wander if there is any plastic surgery that can put a small implant to make my shoulders somewhat wider because whatever i wear my body looks like child’s body because of my small shoulders. I drew an imaginary picture about the size of the implant if it is possible to be done.
A: The shoulder implant to which you refer is known as deltoid implants. Making the shoulders bigger/broader requires deltoid muscle augmentation. Implants are available to augment this muscle and the key to their placement is the location of the incision, the position of the implant over the muscle and the size of the implant. The deltoid implant is unique amongst all body implants because it is placed over/near a moveable joint. (shoulder) While deltoid implants can be placed by a direct incision over the shoulder, the prominence of that scar merits it being done from an incision behind the shoulder at the junction of the shoulder and the back.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in deltoid implants which amongst other procedures as I learned you are very skilled at. I have pictures for my shoulder which are attached. The dimensions for the augmentation are 16cm measured from clavicule down lateral view to end of the deltoid in the center line, the widest part is around 10cms with a projection of 2 cm.
A: Thank you for sending your shoulder augmentation desire and dimensions. Deltoid implants are one of the most uncommon type of body implants but requested for them are becoming more frequent. One of the reasons I asked for them is to have a vision as to where the patient sees the location of the deltoid augmentation and the dimensions that the implants have to be. As there is no off-the-shelf premade deltoid implants, I have to either use an existing style of body implant (usually a calf implant or a custom silicone carving block) or have a custom one made. As it turns out there is an existing silicone carving block with the dimensions of 16 cms long, 9 cms. wide and 2 cms. high. So that does fit the dimensions you have given although although that is probably a bit big. A more appropriate deltoid implant size would be 14cm long, 7 cm wide and 1.5 cm high. The other consideration is knowing the location and the implant size I have think about the incisional location to put it in during surgery. Usually this is done from the back side of the shoulder rather than a direct incision over it.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in getting deltoid and biceps implants. I am not a body builder nor am I trying to bulk myself up. I have a congenital deformity involving my left shoulder and arm. No one knows why but it never developed right and my shoulder has a big indentation in it and is very embarrassing for me. I also can not lift my left arm even up to 90 degrees on that side. I just want to look more normal in appearance. I have attached some pictures for you to see and tell me what you think.
A: I can see that you have an ipsilateral deltoid hypoplasia. It almost seems that there is a general delto-pectoral hypoplasia present on your left side. Deltoid augmentation would definitely help for symmetry. The question is whether this should be done with an implant or fat injections. Each has their own distinct advantages and disdvantages. The advantage of an implant is that the volume would be stable. Its disadvantages are that there is no preformed implant that matches your deformity, it requires an incision for placement, the outline of the implant may be visible, there is a risk of infection and the location of the implant may interfere with raising your arm. The advantages of fat is that it would have none of the aforementioned complications of an implant because it is natural and could be tailored better to the entire shape of the deltoid deformity. Its disadvantage is that its volume retention is not always predictable.
From a biceps standpoint, I see no specific hypoplasia on the same side. They appear symmetric between the two sides. I am assuming that the request for biceps augmentation is to simply augment what you already have, not correct a deformity.
Q: I am interested in getting deltoid implants. I realize this is a new procedure. What can you tell me about it? Thank You
A: Deltoid augmentation is a procedure for those that wish to have more bulk and definition in the area of the upper arm. Previously used in patients in need of shoulder reconstruction after trauma or cancer surgery, deltoid prostheses have been used to safely produce bulk in the shoulder region. Soft solid silicone implants can be fashioned (there is no established deltoid implant shape) to not only give bulk to the deltoid region, but also to give it more definition and shape. This is an example of a ‘muscle-building’ implant like that of the pectoral or gluteal muscles.
The deltoid is the muscle that forms the rounded contour of the shoulder. It covers both the front and back of the shoulder and has its name because it is in the shape of the Greek letter, Delta or triangle. It is a common injection site for injections and most people have probably had an injection there at least once in their life. It originates from the bones of the shoulder (clavicle and scapula) and crosses across the shoulder area to eventually be inserted by a thick tendon to the humerus bone of the upper arm.
The deltoid implant is placed through an incision on the back of the shoulder just above the armpit where the lower edge of the muscle is. The fascia (outer covering of muscles) that covers the muscle is then cut and a pocket made for the implant. The implant is then placed in the pocket just below the fascia of the muscle. The muscle lining is then sutured as well as that of the overlying skin. Once healed, the implant forms a permanent lining (capsule) which keeps it in place permanently. Recovery is largely one of swelling and muscle discomfort. One should not work out for a month after surgery.