Introduction to Pectoral Augmentation
Pectoral augmentation is one of Dr. DuPéré’s specialties, and as you may know, only a few plastic surgeons perform these procedures in North America.
For the longest time, plastic surgeons were focused solely on the female’s anatomy. But 10-15 years ago, this started to change. First in South America, then the rest of the ‘beach heavens’ and now North America. Most of us have been on beaches either in Florida, the Caribbean or better yet, on the 8000 km of Brazilian beaches. Most men would be happy with a fuller and more defined chest, a distinct crease under the nipple area, a clear upper chest fullness, a defined midline muscle edge, no fat in the outermost chest part, flat nipple-areolar complexes, etc.
Some may not have time to go to the gym and some do go, but the pectoralis muscles refuse to hypertrophy. Some have excessive amount of fatty tissue which ‘hides’ the pectoralis definition. Others have excessive amount of breast tissue (medically-termed gynecomastia or layman-named “men’s boobs”). Many have a combination of the above.
Dr. DuPéré initially learned the procedure in 2004, after learning the axillary approach of female submuscular breast augmentation. He subsequently added his experience with this technique for the male chest, combining it with adjunct procedures such as liposculpture, etching and gynecomastia surgery.
Dr. DuPéré has been performing this procedure since 2004. This has now become a very popular procedure in his practice.
As an added benefit, pectoral augmentation will also provide a lift of the soft tissue, something that most men get over time.
Aesthetics of the Male Chest
Most of the muscle groups of men have been extensively studied, described and/or depicted by our Renaissance Artists, such as Leonardo da Vinci, and more recently by the Latin and Brazilian artists and surgeons. A strong, manly, alpha-type and ‘leader-of-the-pack’s chest is one with well-defined pectoralis muscles. A well-defined attachment over the entire midline up to the collarbone, a well-defined insertion over the upper arm, a crisp crease under the nipple-areolar complex, a well defined curve up to the underarm, absence of excessive fatty tissue and breast tissue. A well-balanced torso-abdomen is also required. A trimmed and athletic abdomen (stomach) will always complement and enhance the torso, and any definition of the abdominal muscles is a welcome addition to one’s self esteem and masculinity.
It is therefore important to understand that excessive fat over, around and below the chest area can hide all muscle definition. Therefore, many pectoral augmentation procedures will require some liposculpting to the chest itself and to the sides, along with the abdomen and flanks. Etching of the abdominal 6 or 8-pack muscle might also be an option.
The chest area is always evaluated individually as no one body is created the same. Important parameters to consider include: patient’s height, weight, body mass index, muscular habitus, chest’s height and width, the abdomen, outside chest and flank areas. One also has to provide his/her preference, as many shapes, sizes and thicknesses of implants exist.
Etching is a specialized version of a meticulous, selective and planned liposuction to sculpt around your own muscle groups to better delineate their insertions and interdigitations. This is often performed along with pectoral augmentation. Patients must be moderately athletic in order to achieve full definition of the various muscle groups and be able to maintain their results. Post-op pain is similar to traditional liposuction and so are the swelling and bruising. Recovery for etching only differs in that Dr. DuPéré will “splint” all the etched areas with a custom-made shield-like pressure dressing that you wear for 7 days or so. No shower is allowed during that timeframe.
You may visit our Abdominal & Muscle Etching procedure page for more information on etching.
The chest is always evaluated individually, as no one body is created the same. Important parameters to consider include: patient’s height, weight, body mass index, muscular habitus, thigh length and circumference, lower back and flank areas. Ethnic background is important, as well as different cultures, which have different expectations with regards to shape and size. One also has to provide his/her preference, as many shapes, sizes and thicknesses of implants exist.
Finally, whenever liposuction is required, the fat harvested can be used as an adjunct procedure such as fat and stem cell transfer to other areas such as the face.
Pectoral Implant Material
Pectoral implants come in various shapes and sizes. Dr. DuPéré uses the American-made Spectrum Medical and AART products (approved by FDA and Health Canada). With Dr. DuPéré, the patient will pick the size and shape, guided by your chest anatomy, your body proportions and your preferences. A pectoral implant, like the buttock and calf implants, is made of solid yet very soft silicone material like a very soft gummy-bear candy. It does not contain gel; therefore there is no possibility of rupture or leakage. Your own muscle will not be detached during the procedure so its strength will not be affected. You will still be able to – and should – exercise after the recovery period.
The procedure is performed under general anesthesia in a fully accredited surgi-center. Our center is a level-3 accreditation, the maximal level of safety granted by the College of Physicians and Surgeons of Ontario. Dr. DuPéré works with surgical OR registered nurses and board-certified anesthesiologists. He has worked with the same group of hospital-based anesthesiologists since receiving his fellowship in 2001. Consequently this team is very experienced with aesthetic surgery.
The procedure takes approximately 2 to 2.5 hours of surgical time. It would be longer if liposuction and/or etching were required.
The implants are inserted via a 5cm incision within the hair-bearing part of the underarm dome. Therefore, the scar is easily camouflaged once healed, in the shadow of the crease and amid the hair.
The implant is placed under the pectoralis major muscle itself. It is a thick muscle in males and putting the implants under it will help to blunt all edges of the implant so it looks smooth and natural.
Gynecomastia surgery might be required if there is an associated excessive amount of fatty and breast tissue behind the nipple. Liposuction can sometimes be the solution. Alternatively, excision of the excessive gland is performed: a resulting scar for access could be a very small one between 4 and 7 o’clock around the areola or a larger one in case of severe sagginess post weight loss.
Two (2) drains are left in place for 7-10 days and a compression garment will be worn for 4 weeks.
Most patients go home the same day if this is the only procedure they are having. If needed, overnight stay can be arranged at the surgical center with a registered nurse’s supervision.
Risks and Complications
Dr. Marc DuPéré’s duty as a surgeon – and your right – is to discuss the common complications and the rare, but serious ones with you. This constitutes part of the informed consent. Education is always important and knowing the possible risks will make you more attentive to our recommendations in order to avoid them. Your compliance is crucial. Risks and complications with pectoral augmentation are always possible, as with any surgeries, however, have been very rare. Appropriate planning, technique and the patient’s compliance should assure a positive outcome.
Examples of complications:
- Scar (normal fine scar usually the norm, but. stretched scar, thick keloid, indented and hyper-pigmented can occur
- Dehiscence or opening of the wound
- Pain for 1-4 weeks post-op
- Bruising around the surgical sites
- Loss of sensation over the surgical site and around the scar, sometimes over the inner upper arm
- Palpable and/or visible edges of implants: everything is done to avoid this by putting the appropriate implant under the muscle itself. In the rare possibility it happens, fat injection around the edges might be a solution.
- Temporary superficial vein clotting (superficial thrombophlebitis) over the chest or upper arm; this is not dangerous and would improve over 3-4 weeks with anti-inflammatories.
- Asymmetry: asymmetry is a normal occurrence in the human body, but everything will be done to minimize it.
- Seroma: accumulation of fluid around the implant that would necessitate regular aspiration of the fluid and compression. Rarely, if the seroma formation does not stop, drains may have to be reinserted or the implant may need to be removed. We would need to wait 3-6 months and redo the procedure then.
- Infection: very rare but that would require immediate surgical treatment as antibiotics might not be efficient in those cases. If surgical lavage is not successful, the implant might have to be removed, we wait 3-6 months and redo the procedure then.
- Serious bleeding within the inner part of the calf; that could lead to a compartment syndrome – see below
- Nerve and vessel injury: with any surgery, injury to nerve and blood vessels is a possibility, which can result in loss of sensation over an area of the body. This could include loosing some feeling in the nipple complex. Rarely, a motor dysfunction could result.
- Skin necrosis: part of the skin dies due to undo pressure or vascular compromise. Wound care might heal the defect or a secondary procedure.
- Risk related to liposuction, if performed: dimpling, irregularity, fat embolism, too much or not enough fat removal, cardio-vascular issues, etc.
- Sub-optimal fat ‘take’ if fat transfer is performed. Fat transfer is a delicate procedure and there is a limit to the amount the soft tissue can ‘accommodate’ new fat in one procedure. So it is possible that a second procedure would be required and the patient would incur additional fees.
- Deep venous thrombosis: clots within the calf that could ultimately travel to your lungs (pulmonary embolism): gentle movement of the toes and legs post-op help to prevent this issue. This is something more common with ladies, those who smoke and those on the birth control pill or estrogen replacement.
- Migration of implant over time which may require re-operating for aesthetic reasons
- Capsular contracture: the body always forms a layer of thin collagen around a foreign material called a capsule. In less than 3% of implanted patients, the capsule may contract and either move the implant or make it more visible. This could occur anytime after surgery… 6 months, 2 years, 10 years, etc. It is not dangerous. If this is unsightly, we may need to go back in surgery and remove the capsule and re-implant. This is unrelated to the surgical technique and would be associated with additional fees to the patient. A new implant is normally recommended.
- General anesthesia-related issues: heart, lungs, brain, etc.
Recovery after Pectoral Augmentation
Pain will be present anywhere from 3-10 days. Stretching exercises should be initiated on the DAY OF SURGERY: gentle stretching of both arms OUT and UP, several times every few hours when you are awake. This will speed up the recovery.
Short distance ambulation helps to prevent clots in the deep venous system of the legs.
No sports/gym for 8 weeks. No upper chest exercises for 12 weeks. Most people can go back to non-physical work (i.e. desk work) in about 2 weeks post-operatively.
Drains are always used and would typically be removed 7 days post-operatively. Few external stitches might be needed and would be removed 7 days post-op. Tight compression over your chest would also be applied with tensors for 21 days.
Thirty (30%) of Dr. DuPéré’s patients are not from Toronto. Because of his serious and long-standing interest in body implants, and also, because this is a rare expertise amongst plastic surgeons, people come from all corners of Canada for these procedures.
We do offer a Fly-In Package for out-of-town patients. The VISAGE clinic staff is quite accustomed to helping patients with airport and surgical clinic transfers. We also have preferential pricing at various hotels near our clinic to suit any budget.
It is required to stay around Toronto for a minimum of 10 days post-pectoral augmentation in case of emergencies.
If required, we can also arrange any nursing help, post-operatively, for hotel or home.
All cosmetic surgery consultations are with Dr. Marc DuPéré personally.