The augmentation of male chest muscles is a procedure recommended for patients presenting hypotrophy of the pectoral muscles, Poland syndrome (underdevelopment or absence of the chest muscle) or muscle asymmetry. It is also recommended for patients who have disproportional chest muscles in comparison to muscles of other areas of the body, and who have not obtained adequate development of such muscles through physical training and exercise.

Pectoral bioplasty is performed by means of the implantation of PMMA, a liquid implant that is infiltrated intramuscularly. This process is also used for the augmentation of glutes, biceps, and calves, amongst other muscles.
Infiltrative liquid implants have been widely used in aesthetic, plastic and reparative medicine. There is a wide array of these products at use, in different concentrations and for different indications.

The ideal liquid implant needs to have some characteristics, as described by doctor Robert Ersek. In Brazil, studies have found that polymethylmethacrylate (PMMA) possesses these desired characteristics, for it is biocompatible, inert, stable at the place of its application, moldable within a window of time, and permanent.

Results obtained with bioplasty
Muscular hypertrophy: pectoral muscle molded in order to provide better harmony between chest and thorax.

Biomodulation of the male pectoral muscle with polymethylmethacrylate (PMMA) – CASE REPORT

The goal of the following case report is to describe the technique used in a male pectoral muscle augmentation, as well as the results that were obtained with use of PMMA at 30%.
LAG, 31 years old, 80 Kg, came to the Clinic displaying clear signs of disproportion between his chest and the rest of his body (this imbalance was specially noticeable at the biceps and deltoids). He reported having great difficulty in developing his chest muscles, even after years of physical training and exercise. He presented great bone and muscle structure, aside from inadequate size and volume of his pectoral muscles.

Procedure

Prior to the procedure, antisepsis of the area is done using iodophor and the region is then marked. A correct examination of the anatomy is of the utmost importance as to avoid any complications. The liquid implant PMMA is then infiltrated in deep anatomical planes, inside the pectoralis major muscle.
The pectoralis major is composed of two main parts: the sternocostal portion and the clavicular portion. A smaller portion, the abdominal portion, is also a part of the pectoralis major muscle group. Due to the fact that the infiltration is done via a blunt-tipped microcannula that is designed to prevent nervous-vascular lesions, vascular complications are extremely rare. However, in order to secure the success of the procedure, markings drawn prior to the infiltration must be done with extreme care and attention

First, we mark a point at the middle clavicular line to indicate the start of the deltopectoral groove, where the cephalic vein and trunks of the thoracoacromial artery pass. We then draw the outline alongside the sternal portion, 2 laterally to the sternal bone and 2 cm under the nipple.

First, we mark a point at the middle clavicular line to indicate the start of the deltopectoral groove, where the cephalic vein and trunks of the thoracoacromial artery pass. We then draw the outline alongside the sternal portion, 2 laterally to the sternal bone and 2 cm under the nipple.

When marking the infiltration orifice through which the anesthetic and the polymethylmethacrylate filler will be inserted, we must be careful with the nervous-vascular bundle, such as the cephalic vein, drawing 3 cm underneath the clavicular border at the hemiclavicular line. 

After these markings were done with the patient sitting up, a new antisepsis of the area was performed. The patient was then asked to lie down and transparent sterile fields were placed so that we could, jointly with the patient, monitor the evolution of the procedure.

An anesthetic button was placed at the previously appointed area of infiltration and an orifice was then made using a needle 40x12 so that the microcannula could be inserted and the anesthetic could be infiltrated. The anesthetic used was modified Klein solution, consisting of 500 ml of cold SF 0,9%, 1 ml of adrenaline and 10 ml of bicarbonate.

Using the microcannula, 40 ml of the anesthetic solution were infiltrated and distributed through the intramuscular plane. With the same microcannula, we proceeded to infiltrate PMMA at 30% in each pectoral muscle, respecting previously established limits, ensuring that the product did not accumulate in a single place as this could cause granulomas. We also ensured that the product was not applied to the subcutaneous plane, for PMMA at 30% is not intended for use in such manner and inappropriate use of this product could cause its migration.

A massage was performed after the procedure as to spread the product homogeneously.  

15 days after the procedure
Before the procedure

Image 1 – patient 15 days after infiltration of 40 ml of PMMA at 30 % in each pectoral muscle. Notice that all edema has already been reabsorbed, just as the vehicle for the filler used in this procedure. This is the final and permanent result of our procedure.
After the procedure was done, a micropore bandage was placed at the area of incision, 1 amp of diprospan IM was administered and patient started taking prophylacticly cephalexin, 1 gm every 12 hours - orally.

Note that the vehicle for the filler is reabsorbed within 4 days of the procedure and during this time period the implant is still a gel and can be molded. There was a follow-up consultation 3 days after the procedure as to revise its outcome. We recommend avoiding exposure to the sun and to hot objects, as well as manipulating the treated area for 1 week after the procedure. Patient is cleared to return to physical activities after 14 days.

After the vehicle is absorbed, the microspheres of PMMA at 30% of 50 micra in diameter are primarily invaded by neutrophils and then by macrophages that will stimulate the production of collagen and local fibrosis, making this implant permanent and no longer absorbable by the body.

DISCUSSION
The procedure is done as an outpatient procedure, without the need for post-op, with local anesthetics and in the patient can actively participate and observe all of the proceedings. It is simple and fast, and results are permanent.

There are no counterindications for PMMA use, though it may not be applied to infected areas and in patients with history of bleeds. The procedure is permanent; stable at the location it was applied to, moldable within the first few days of application, and inert.

My personal experience demonstrates an extremely high level of satisfaction of patients treated with PMMA, applied not only to the pectoral muscles, but also to glutes, nose, biceps and face, amongst other areas.

Studies show complications in 0.05% of cases, given that edema is considered the main complication, as described by Dr, Rosana.

After years of physical training and exercising, the patient mentioned in this case report had lost his self-esteem and had begun to doubt that exercises could bring better health and well being. Today, the patient is very satisfied and has returned to his exercise routine. He also states having better self-esteem and confidence, and that he is more active and social.
The technique for infiltration of liquid implants has been strongly disseminated amongst medical professionals, especially those who practice aesthetic medicine. If serious and competent professionals perform this technique in a proper manner, complications are extremely rare and patient satisfaction is very satisfying.

The Leger Clinic specializes in Liquid Implants. We receive a great number of out-of-state and international patients who seek our services in Bioplasty and Corporal Biomodulation.

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