Pectoral Implants
- Author: John M Anastasatos, MD; Chief Editor: Jorge I de la Torre, MD, FACS more...
Background
Pectoral implants are used primarily for aesthetic enhancement and improved delineation of the male chest. Less commonly, pectoral implants are used to treat pectus excavatum, pectoralis muscle tears, and Poland syndrome. This article focuses on the use of pectoral implants for cosmetic enhancement in male patients. See the image below.
Right side view of same patient before and after pectoral implant surgery. History of the Procedure
Initial reports of usage of customized silicone implants for correction of thoracic deformities come from experience in the treatment of pectus excavatum.[1, 2] One of the main problems associated with such implants was the lack of sufficient tissue coverage because of the subcutaneous/subglandular placement of the implants.
Aiache is credited with the first cosmetic use of silicone implants that were placed under the muscle, which provided much more natural-looking results.[3] He also designed one of the most widely used types of silicone elastomer implant for this purpose.
Problem
Some men are unable to develop their pectoral muscles with exercise in proportion to the rest of the body. For certain men, this is a cause of low self-esteem. Addressing this disproportion is the most common use of pectoral implants. Infrequently, pectoral implants are used to treat pectoralis muscle tears, Poland syndrome, and pectus excavatum.
Epidemiology
Frequency
The frequency of pectoral implants is low. Published data from the American Society of Plastic Surgeons report 1335 such operations performed by ASPS members in 2008.[4] The ASPS tracks data from its members only. The actual number of such procedures performed is higher because other physicians who are not plastic surgeons also perform them.
Etiology
The patient desire for placement of pectoral implants is mostly for aesthetic enhancement. Very rarely, conditions that cause anatomic and structural irregularities of the chest wall may require pectoral implants for improvement.
Indications
The indications for pectoral implants are based on patient demand and need in certain reconstructive operations. As noted above, the procedure is most often performed for the purpose of aesthetic enhancement but can be performed to treat pectoralis muscle tears, Poland syndrome, and pectus excavatum.
Relevant Anatomy
The pectoralis major muscle has 3 components: the clavicular head, the sternocostal head, and the abdominal head. The muscle originates from the medial half of the clavicle, the sternum, and the upper 6 costal cartilages, and inserts onto the lateral tip of the bicipital groove of the humerus.[5]
The dominant arterial supply to the muscle is the thoracoacromial artery. The thoracoacromial artery gives off 4 branches: pectoral, armorial, clavicle, and deltoid. The pectoral branch of the thoracoacromial artery is the largest.[6] This branch enters both the pectoralis major and minor at the midportion of the clavicle. It courses laterally for about 4 cm until it reaches its axis (from the acromion to the xiphoid); then it turns around and runs across this axis distally.[7] Additional blood supply to this muscle comes from the intercostal perforators, the lateral thoracic artery, and the superior thoracic artery. The thoracoacromial artery can be seen running at the undersurface of the pectoralis major muscle in a fibrofatty plane.
The motor innervation comes from the medial and lateral pectoral nerves. Sensory innervation comes from the intercostal nerves.
The pectoralis minor muscle lies underneath or posterior to the pectoralis major muscle. The 2 muscles are separated by a loose areolar plane. The proper placement of the implant used for pectoral augmentation is between the 2 pectoral muscles. See the image below.
The implant is placed under the pectoralis major muscle and over the pectoralis minor muscle. The pectoralis minor muscle extends from the coracoid process to the third, fourth, and fifth ribs. Its arterial supply is also from the pectoral branch of the thoracoacromial artery and branches of the intercostals arteries. Its nerve supply is from the medial pectoral nerve.
Contraindications
Poor overall health and unrealistic patient expectations are contraindications to the performance of this procedure.
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Lavey E, Apfelberg DB, Lash H, Maser MR, Laub DR, Gosain A. Customized silicone implants of the breast and chest. Plast Reconstr Surg. Apr 1982;69(4):646-51. [Medline].
Aiache AE. Male chest correction. Pectoral implants and gynecomastia. Clin Plast Surg. Oct 1991;18(4):823-8. [Medline].
American Society of Plastic Surgeons (ASPS). National Clearinghouse of Plastic Surgery Statistics: 2009 Report of the 2008 Statistics. ASPS Web site. Available at http://www.plasticsurgery.org/Media/stats/2008-US-cosmetic-reconstructive-plastic-surgery-minimally-invasive-statistics.pdf. Accessed July 20, 2009.
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Hodgkinson DJ. Chest wall implants: their use for pectus excavatum, pectoralis muscle tears, Poland's syndrome, and muscular insufficiency. Aesthetic Plast Surg. Jan-Feb 1997;21(1):7-15. [Medline].
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