Pectoral augmentation (Pectoralis major)

The pectoralis major, the big breast muscle, 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 sub muscular 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.