Many areas of the body can be augmented and enhanced but the issue is often the location of the scar. Fortunately for men, one underarm incision can do all 3, that is one axillary incision will allow me to insert a pectoral, a biceps and/or a triceps implant(s). The incision is the same used in axillary (underarm) breast augmentation. The incision is in the dome in the axilla, within the hair-bearing part, therefore, well-hidden. Also, since our arms are most of the time at the sides of our body, the incision tends to heal with zero tension and therefore results in a super fine barely visible scar, even in the hairless underarm.
The implants are all made of very soft and flexible but solid medical silicone, same as our buttock, chin, temple, calf and jaw angle implants. Since they are enhancing muscles, the solid but soft implants are considered stronger to sustain the pressure a muscle is meant to endure, hence the silicone gel implants are not an option. The edges are tapered and thin at the edges. The advantage of the solid implants is also that they are carvable by the surgeon so artistry will be desirable when choosing your aesthetic plastic surgeon. The pectoral implants are inserted under the pectoralis muscles and therefore over the ribs. The biceps and triceps implants are not as deep but still implanted under the white layer covering each muscle called the fascia (going deeper has a high risk of serious motor nerve injury).
Implants can also be customized to patients but their cost is much higher due their single and unique production. Fortunately for the patients, patient-specific custom-made implants are rarely required unless I am treating a patient with pectus excavatum or Poland’s syndrome.
It is quite common that a male wants all 3 muscle groups augmented at once. When doing so, although I use only one incision in the underarm, I like to create 3 different “roads” of dissection as to not have connecting “spaces” inside. This concept is important as should a post-op issue arise in one area, the other implant(s) do not also become involved. Such issues are rare but would include infection, bleeding (hematoma) and/or seroma.
Infections are rare but difficult to treat should they arise since the pectoral, biceps and triceps implants are not human material and are not vascularized; therefore, antibiotics given 1-2 weeks post-surgery to treat a possible infection would not carry the antibiotics to the implants. It is the same situation as in breast and buttock augmentation, chin and cheek augmentation, temple and jaw angle augmentation. Infections are minimized with a thorough surgical antiseptic cleansing, sterile surgical and implant protocol and with the use of intraoperative intravenous antibiotics (always given before the first incision, as done with all types of skin and soft tissue surgery) and with the continuation of several days of oral antibiotics. I should also mention that the implants will be bathed in antibacterial solution and each surgical implant pocket will be washed with the same solution. Whenever possible, the Keller funnel will be used again to minimize contact of the implants with the patient’s skin. We also want our males to shave their underarms 3 days pre-surgery and not the night before. If the male forgot 3 days before, it is then best to wait for the surgical team to do it at the surgical time (it was showed before that doing it 12-24 hours before surgery increased the risk of infection).
Hematomas (large collection of blood) are rare since the sub-pectoral plane is relatively avascular and the under-fascia space is avascular. Hematomas are usually prevented by having the patient avoid blood thinners 10 days pre surgery such as:
- platelet-inhibitors (Plavix, Ticlid, etc.),
Avoid also ADHD medications:
- Adderall (amphetamine)
- Ritalin (methylphenidate)
- Concerta (methylphenidate)
- Focalin (dexmethylphenidate)
- Daytrana (methylphenidate patch)
- Metadate or Methylin (methylphenidate)
- Dexedrine or Dextrostat (dextroamphetamine)
Finally, avoid also Coumadin (with your prescribing doctor’s approval) and all over-the-counter osteopathic and naturopathic medicines, such as:
- St. John’s wort
- primrose oil
- omega-3 fatty acids – found in fish oil
- vitamins C and E
Drains are often used for the pectoral augmentation procedures since the insertion of the pectoralis muscle are often stretched to give the males a more defined and close-in-the-midline masculine cleavage.
Seromas are very rare in those procedures. Seroma is the accumulation of clear yellowish inflammatory and healing fluid in a surgical pocket. We prevent them with pressure dressings and should they occur, usually one or serial aspirations post-surgery are easily performed during follow-ups until the pocket heals up.
Some minor skin nerves do cross the underarm incision area and could inadvertently be stretched or cut, resulting in temporary or permanent loss of sensation over the inner arm or inner forearm. Again, this is rare and when it occurs, new nerves will often grow into those areas over one to two years.
Finally, capsular contracture is possible with secondary displacement of the implants and/or palpable/visible edges in very thin patients.
Over 19 years, I have accumulated a vast expertise in implant augmentation surgery from head to calf.
Dr. Marc DuPéré, aesthetic plastic surgeon