Your Questions
Your Questions
Q: Dr. Eppley, I am interested in pectoral implants. I had gynecomastia reduction done twice in the last 10 years. I still have divets because I think too much tissue was removed on the outside areas of my pecs. I am also considering pectoral implants to even this out and provide a more contoured even look. I work out often and I still am not able to get my pecs looking good. I have read about your expertise with male cosmetic enhancements.
A: It sounds and looks like the combination of pectoral implants combined with some fat grafting to the nipple-areolar divots would create a more contoured chest result. It is hard to argue with the immediate and dramatic improvement in chest shape that pectoral implants can create. But they alone would not fix any indentations from over resection from gynecomastia surgery. That will need to be addressed directly with fat grafts put right into the soft tissue defects.
Gynecomastia reduction, particularly if done by liposuction, can often leave the chest looking deflated particularly in older men. Pectoral implants can make for an instant change in chest size through muscle enhancement.
Dr. Barry Eppley
Indianapolis, Indiana
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
Indianapolis, Indiana
Q: Dr. Eppley, I am a 32 year-old male that has Poland’s syndrome and am interested in pectoral implants. Can you fix my chest?
A: I can see from your pictures that you have a mild case of Poland’s that has affected the right side of your chest. The right pectoralis muscle is a little bit smaller and the nipple-afeolar complex on the right side is a little higher. I suspect that when you raise your right arm, compared to the left side, that the asymmetry between your chest sides becomes even more apparent. There are two approaches you can use for your improving the appearance of your Poland’s chest deformity. One approach is to just place a small pectoral implant on the right side with a nipple lowering procedure. Fat injection grafting as opposed to an implant can also be used although it is less reliable than an implant in terms of permanent volume. A second approach is to enhance both sides of the chest with pectoral implants (right bigger than left) with a right nipple lowering procedure. The choice between the two depends on how you view the normal left side of our chest. If you are happy with it, then you go with the first approach. If you are looking for improvement on both sides, then you go with the second approach.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, have there been any improvement to help with outpatient healing for pectoral implants? Having helped with liposuction recovery and breast implants it looked pretty brutal seeing the fluids and bruising/swelling and that didn’t involve having to fly back home. I’d consider it to get that permanent sculpted definition in the upper chest if possible, just seems like it has be done a little more artistically on a male than female to get the correct look as too large would look too unnatural.
A: Pectoral implants are in some ways very similar to breast implants but are a bit different. Pectoral implants are solid elastomer implants not fluid filled, thus they will never rupture or need replaced. While they are placed below the pectorals major muscle, unlike breast implants they are are not placed below the lower pectoral line which means there is less soft tissue dissection and no disruption of the muscular attachments. There is no the same amount of bruising or swelling as with breast implants an no fluid drainage like in liposuction. While it is a muscular recovery, I would not consider it ‘brutal’ or that severe.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting pectoral implants to make my chest bigger. My two very important questions are does the implants distort upon muscle contraction when placed under the muscles? And to create the “pocket” for the implant you need to detach the muscle from the sternum right? Thanks for getting back to me.
A: While there are some similarities between pectoral implants and breast implants, there are difference between them that are more just that one is for men and the other is for women. The implants themselves are different with pectoral implants being a soft but solid silicone elastomer while breast implants are filled with non-solid fillers inside a thin flexible silicone elastomer bag. As such, breast implants can fail and need to be replaced while pectoral implants can not fail and never need to be replaced.
Pectoral implants are put in through an incision in the armpit (just like some breast implants are) and are placed in a completely submuscular pocket. Conversely, breast implants are placed in a partial submuscular pocket often referred to as a dual plane location (part under the muscle and part out of the muscle. When you think of implant distortion with muscle contraction you are thinking of breast implants where half of the implant is not under the muscle and thus distorts when the muscle pushes down on it, causing the implant to move to the side and causing some degree of implant distortion/movement. Neither in breast or pectoral implants is the muscle detached from the sternum at either its origin or insertion. The pockets are created by entering a tissue plane underneath the pectoralis major muscle.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 45 year-old man that would like to improve my body. I am a little overweight and I seem to carry all of it in my belly. My chest and arms have no muscular definition and I would like implants to pumo them up. I have attached some pictures. Tell me if you think I am a good candidates for these procedures.
A: Thank you for your inquiry and sending your pictures. In considering your request, the first issue is that of your belly. (abdomen) Given that you are a male with a round firm belly, it is important to realize that a significant part of the abdominal fat you are seeing is intra-abdominal (around the organs) and not extra-abdominal (between the muscles and the skin) where it can be reached by liposuction. That is a unique feature of most men that have large bellies. While there is some fat that can be suctioned, the critical question is whether it is enough to justify the surgical effort. If I examined you I would know by feel. But in just looking at your pictures, I am concerned that the result obtained may not meet your expectations. Liposuction will help but it is not magical and it will not make your abdomen flat. The only way to get closer to what you desire is a combination of liposuction and weight loss. Liposuction will likely only get you halfway there.
When it comes to body contouring implants, like pectoral and arm implants, it would first be appropriate to get your abdomen in better condition. Given your abdomen the way it is now, pectoral implants would merely get lost in the shape of your body and may not make enough of a visual difference to justify the effort. At the very least, you are not now a candidate for arm implants. Body implants in general work and look best in men who are at a good body weight and are lean enough that the profiles of the implants can be seen.
In conclusion, the only option I would consider at this point is abdominal and flank liposuction and possibly pectoral implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to have a more shapely and manly chest. I have worked out a lot and simply can’t build up my pectoral muscles very much. It almost seems like I have a muscular deficiency in this area, they just won’t build up to my liking no matter how much iron I pump. I think the only way I am going to get there is with chest implants. Can you tell about how the operation is done and what type of implants are used? I assume it is pretty much like breast implants for women.
A In many ways, you are correct about the similarities between male pectoral implants and female breast implants. Like saline breast implants, pectoral implants are put in through an armpit incision (transaxillary approach) and are placed under the pectoral muscle. Unlike breast implants, however, the positrion of pectoral implants does not extend below the lower border of the muscle. This is a subtle but important placement issue to get the best increase in pectoral muscle outline. The biggest different is in the type of implant used. Pectoral implants are made of a solid (non-fluid filled) silicone elastomer material. It is very soft and has a spongy feel. They can not rupture or ever degrade and will never need to be replaced, which is very different from breast implants which have a limited lifespan.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I am an amateur bodybuilder and I have very large pectoral muscles as you can see in my photos. I feel I have achieved as much size as I can through exercise and that my only options for increased size are implants or anabolic steroids. Since steroids are illegal, I am interested in knowing whether I would be considered for pectoral implants and what amount of size and projection increase I could expect.
A: The common use of pectoral implants is for men who either need reconstruction for congenital pectoral/chest asymmetry or cosmetic chest enhancement for those that have not had good success with pectoral enlargement. Your chest shows considerable pectoral muscle enlargement as you have mentioned and your picture shows. The question is not whether you can have pectoral implants but whether the sizes that are commercially available will make enough of a difference to justify the effort. The typical size of the largest pectoral implants is around 350ccs with maximal projection of about 3 cms. How much of a difference that will make in your chest size in not exactly predictable. Knowing your exact chest dimensions in height, width and thickness for each perctoral area would be helpful in answering this important question. Based on the picture alone, I would estimate that the change would be in the range of a 20% to 30% increase…but that should be interpreted as a guess based on inadequate information as of yet.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in pectoral implants and would like any information about the procedure that you can share with me.
A: There are tremendous similarities between transaxillary breast augmentation in females and pectoral implants in men. They both are placed through an incision in the armpit with a pectoral implant needing more length as the implant is bigger. Both are placed under the pectoralis muscle with a pectoral implant not being placed below the lower edge of the pectoralis major muscle. All of the pectoral implant remains covered by the muscle to give it maximum bulk and projection. (a breast implant in contrast often has at least half of the implant below the edge of the muscle) Pectoral implants come in numerous sizes and shapes from oval to a more square design. The implant selection is determined by measurements taken on the chest based on the outline of the muscle. The implants are composed of solid soft silicone elastomer material that behaves like a flexible gel. The material is inert and will never degrade or break down. Pectoral augmentation is performed as an outpatient procedure done under general anesthesia. Dissolveable sutures are used to close the armpit incision. After surgery, there will be some swelling and soreness and a chest wrap is used for comfort. One can expect that it will be about three weeks until one has full range of motion of their arms and can begin to return to working out again if desired.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in getting pec implants. I have always had a very flat chest with little muscle definition at all. I have done a lot of chest exercises but I have not seen a lot of improvement or at least the amount that I want. I have tried protein supplements, testosterone and even some human growth hormone but I just can’t get the size of pecs that I want. This has brought me to the conclusion that the only way I am going to get there is with an implant. Do you think pec implants will finally help me get what I want?
A: There is no question that pectoral implants will increase the perceived size of your pectoral muscles. Increasing the bulk of the muscle is what they do best from their subpectoral or under the muscle position as they push the muscle forward. Implants are not quite as good as improving pectoral muscle definition with the exception of the lower lateral pectoral border. The question you are really asking probably relates more to implant projection…or how big can the pectoral muscles be made to look.
Pectoral implants have, at most, up to 3 cms. of projection or forward push of the muscle. How significant that is depends on how thick the muscle is to start with. In other words, a flat chest with a thinner pectoralis muscle will show more but it will not be a ‘bodybuilder-like’ result. An already thicker pectoralis muscle in someone who is fairly developed will have a much more prominent result.
Indianapolis Indiana