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Pectoral augmentation
(Pectoralis major)
The pectoralis major, the big breastmuscle, can be congenitally
underdeveloped or totally missing, on one or on both sides. This is called Poland's
Syndrome. Certain diseases can inhibit the muscular development or cause a muscular
degeneration, like polio or paralyses. The muscle can of course degenerate by
physical inactivity as well. The pectoral bulks dominate the contour of the chest
and gives an athletic look of the chest. The
extreme awareness of the body nowadays, seen as the popping up of fitness-studios,
makes people more concerned about the shape and volume of their muscles. In spite
of hard training the desired shape might not be achieved and all these factors
might give a desire for surgical pectoral augmentation. All
these conditions can be improved by replacement or augmentation of the muscle
by implants. Principle:
A solid but soft implant made of silicone is inserted through the axilla. The
shape and size of the implant can vary. Either can the belly be augmented with
a spool-formed implant or the whole muscle be augmented with an anatomic shaped
implant. Methods:
A 4 - 5 cm long incision is made high up in the axilla. If the muscle is missing,
a pocket is developed under the skin. Otherwise a pocket is dissected under the
muscle, just as big as the implant is. If the pocket is made bigger, the implant
can dislocate. The pocket and the skin are closed. A compressive and fixating
bandage is applied for one week. Anaesthesia:
In Poland´s syndrome, the procedure can be made in local anaesthesia combined
with heavy sedation. In pure submuscular augmentation, general anaesthesia is
preferred. Operating
time: 1 - 2 hours. What
happens afterwards?
 | During
the first 24 hours there will be some heavy, tensile pain, which will gradually
disappear during the first week. Painkillers will be needed. |
| Antibiotics
and anti-inflammatory will be prescribed for 7 days. | | Initially
the breasts will be swollen. The swelling disappears gradually during the first
month. | | The
stitches are removed about the 10th day. | | One
should sleep on the back. | | Avoid
moving the arms over the horizontal plane or restrict moving the arms to prevent
for dislocating the implants. | | Avoid
car driving during the first week. The same reason as above. |
| Restrict
from physical activities for 4 weeks. | | The
time off is 1 - 2 weeks depending on activities. | |
Connective tissue surrounds the implants and keeps them in place if the implants
are "immobilized" the first 3 - 4 weeks. | | Transient
numbness or hypersensitivity over the muscle is not unusual during the first 1
- 2 months. |
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COMPLICATIONS
Referred unwanted biologic events can occur with a certain low frequency and must
be regarded as calculated risks. Other risks not mentioned can also occur. For
patients this must be considered before a decision for plastic surgery is set.
Bleeding:
All operations can cause postoperative bleeding. These risks increase by the intake
of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned
operation. Infection:
All operations can cause infections. An implant has to be removed temporarily
and can be reinserted after a few months in case of infection. Capsular
contracture: Every foreign body causes a formation of surrounding connective
tissue, a capsule. If this capsule contracts, the implant can be deformed. Dislocation:
The implant can be dislocated or change position. This is often due to direct
injury to the muscle. Scarring:
All scars are red for a couple of months and they fade away during the fist year.
Direct sun or solarium against the scars should be avoided to prevent them for
permanently become red or pigmented. The scars are normally very discreet. Smoking:
Smoking does compromise blood circulation and healing. Smoking should be abandoned
prior to a planned operation | This
text is edited and controlled by Dr. Per Gunnar Opitz, Opitz plastikkirurgiska
klinik i Malmö Sweden | 
