PEER
PEER REV E
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VIEW | BODY CONTOURING | prominences and scoliosis. Physical evaluation is with
the muscles relaxed and during contraction. Dynamic evaluation is very important because the muscles change in shape and length, and this has to be taken into account for choosing the proper implant. Implants are available from Polytech Health &
Aesthetics GmbH (Dieburg, Germany) and from Silimed (Rio de Janeiro, Brazil). Both manufacturers have three sizes available: 190 ml (width 14.4 cm, height 2.4 cm), 230 ml (width 15.8 cm, height 2.6 cm), and 300 ml (width 16.5 cm, height 2.9 cm). Implants from Polytech and Silimed are microtextured, while those from Silimed can be either textured or smooth. The incision made in the axilla is transverse for the manufactured pectoral implants and longitudinal, following the posterior aspect of the border of the pectoralis muscle, for the custom-made implants. The mean length of the incision is 4 cm.
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Figure 5 (right)
igure 5 (right
Montellano Montellano
implan for calf implant ft or calf augmentat on anatomic)
augmentationi ( (anat
Similar to axillary breast augmentation, the initial dissection is subcutaneous and a 3–4 cm tunnel is made caudally. The lateral border of the muscle is identified and a pocket is created behind the muscle, initially with scissors and then with a blunt dissector. The muscle is never detached; otherwise, the implant will be positioned too low, resulting in a feminine appearance. Laterally, the author performs a blunt dissection to make room for the implant, stretching out the fascia to the width of the implants. Non-steroidal anti-
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inflammatory drugs (NSAIDs; e.g. ibuprofen) and antibiotics are given for 1 week. Compressive garments are not prescribed. Patients are instructed not to do any strenuous activity for the first 6 weeks. They can elevate the arm to stretch the muscles and the axilla. It is normal to feel tightness in the axilla for some weeks, until the scar softens. For most patients, commercially-available implants
give a very natural profile and are enough for their expectations (Figure 2). In some cases, however, custom-made implants are required. These implants comprise silicone elastomer and are less pliable. With them, it is possible to solve some requirements, such as filling the infraclavicular area (Figures 3 and 4). The total number of patients treated in the author’s
34
clinic for chest enhancement (excluding those with muscular injuries and Poland syndrome) has been 28 between 2003 and June 2010. In one case, the author placed 300 g implants. Eight patients had 190 g implants and in the remaining patients (16), 230 g implants were used. In three patients the author used custom-made
b July/August 2014 | July ugust 2014
prime-journal.com
implants. The main complication has been seroma, which affected four patients. In one patient with seroma there was bilateral infection and the author had to remove the implants.
Calves Men who visit the author’s
office usually complain of a lack of development despite intense training, and they see an imbalance between the well-developed thigh and their lower legs. In this area, the desire is to achieve well-defined and contoured
calves, and for that the author will need two implants for each leg in the majority of cases. Patients often want the maximum diameter
possible. The implant that the author uses for the medial gastrocnemius is anatomic shaped,
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