Pectoral Implants

Who it’s for

Someone at least a year past top surgery, with a chest that is flat and settled but stays small however hard they train. Lean people suit implants best. There is less soft tissue to hide an edge, which sounds like a disadvantage. But on a lean chest the implant reads as muscle, because there is nothing else it could be. On a softer chest it can read as a lump.

Who should look elsewhere. Anyone who has not given testosterone and a proper training block a real go. A surprising number of chests get there on their own, and an implant cannot be undone without another operation.

Anyone with loose skin or a marked asymmetry left over from top surgery, because the implant will sit under those problems, not fix them. And anyone hoping for a chest that moves and hardens like muscle, because it will not. The muscle over the implant still does that; the implant just sits underneath.

Testosterone is not required, though most people having this are on it. Nicotine has to stop, since the pocket has to heal tightly around the implant, and surgeons want a stable weight. See eligibility.

Before you book

Give the gym one more honest block on testosterone before you decide, and take photos at the start and end. If the chest changed, keep going. If it didn't, you will walk into the consultation certain, and that certainty is what makes this the right operation.

How it’s done

Standing up, the surgeon draws the outline of your pec on your chest, with the lower and outer borders of the muscle marked. The implant has to sit inside those lines, so this is where the shape is decided. The implants themselves are solid, slightly flexible silicone, shaped like a pec, and come in a range of sizes. Some surgeons order them custom-made from a scan.

Under general anaesthetic they make a short incision in each armpit, or open a section of the existing top surgery scar if it sits in a useful place. Through that they lift the pectoralis major off the chest wall to create a pocket the size of the implant and no bigger.

That tight fit is what stops it moving later. The implant is slid in and positioned so its lower edge lines up with the border they drew. The muscle is laid back over it and the incision is closed. Drains are used by some surgeons and not others. You wake up in a compression vest.

The lifting of the muscle is the whole of the operation, and it is the part you feel afterwards.

The week before

Practise getting in and out of bed, and pulling a shirt on, without using your arms to push or reach. For the first week you will be doing both with your pecs off limits, and it is easier to learn the moves before you have to.

Pec implants recovery

The first few days feel like the worst chest workout of your life, plus a vest. The muscle has been lifted off the chest wall and everything from reaching to laughing pulls on it. Sleeping propped up and keeping the elbows below the shoulders are the two things that make it bearable. By the end of the first week most people are moving normally around the house, carefully.

After that the job is to leave the implants alone. No chest or arm training until the surgeon clears it, which is about six weeks for most. The pocket has to scar down around the implant before it is loaded. The chest looks bigger than the final result for the first month or two while the swelling settles. Tightness across the chest, and a feeling that something is under the muscle, both fade over roughly three months.

In the first month

Treat the lifting ban as the operation's second half. The pocket only holds the implant still once it has scarred down around it. The people who end up back in theatre for a shifted implant are mostly the ones who tested it early.

Pec implants scars

If the surgeon goes through the armpit, one short scar in each, a few centimetres long, sitting in the crease. It is hidden with the arms down and fades to a pale line over a year. If they reuse the double incision scars instead, nothing new is added, though the section they open may heal a little wider than the rest.

Nobody chooses this operation, or a surgeon for it, on the scar. It is chosen on the shape.

Sensation after pec implants

Nipple sensation is not affected. Whatever you had after top surgery, you keep. The implant goes under the muscle and the nerves to the nipple are not in the way. The skin around an armpit incision goes numb for a few months and then mostly recovers.

The stranger feeling is the implant itself, a firmness under the muscle that you notice when you press or lie on your front. Most people stop registering it within a few months.

Risks and complications

The early risks are the usual ones for a pocket under muscle. A bleed into the pocket in the first days, a seroma, a pocket of fluid that may need drawing off, and infection. An infected implant usually has to come out, and go back in months later once everything has healed. That is the outcome to avoid, and why nicotine matters.

The problem specific to pec implants is movement. An implant that shifts upward, outward or rotates in its pocket is visible, and it needs another operation to reposition it. Published figures are thin, but the surgeons I have asked put it at a small minority, and higher for people who load the chest too early.

Asymmetry between the two sides, and an edge that shows on a very lean chest when the arms are raised, are the later cosmetic complaints. Capsular contracture, where scar tissue tightens round the implant, is less common with solid implants than with breast implants but still happens.

Pec implants results

At three months, a chest with the fullness and the defined lower pec line that training could not produce. The implants are permanent and do not need replacing on a schedule. Because they sit under the muscle, any muscle you build afterwards adds on top of them.

What disappoints is the close-up. An implant does not harden when you tense, so the pec looks built at rest and does not change when you flex. On a lean, trained chest that is barely noticeable. On a softer chest, or one where the implant is too big for the muscle over it, the outline can read as an implant. The people happiest with this are the ones who chose a conservative size.

Alternatives to pec implants

The first alternative is more time in the gym on testosterone, and I would want to hear that a surgeon had asked about it. Chest muscle responds to testosterone for years, and plenty of people who feel stuck at two years are not stuck at four. If you have done that and the chest is still flat, the question is how much change you want.

For a small, softer increase in fullness, fat grafting to the chest uses your own fat, avoids an implant and its risks, and recovers faster. Part of the fat is reabsorbed by the body and the change is modest, so it does not give the defined lower edge. For a bigger, more sculpted change, implants are the only option that adds mass directly. Some surgeons combine the two, using fat to soften the edges of an implant.

Combining pec implants with other surgery

Pec implants are sometimes combined with liposuction of the sides or abdomen, since both are done by the same kind of surgeon and the vest covers both. They are rarely done at the same time as top surgery, because the surgeon wants to see the healed chest before deciding the implant size. See surgery order.

Pec implants cost

Insurers treat pec implants as cosmetic, including after a funded top surgery, so this is self-pay almost everywhere. Ask for the all-in quote covering surgeon, anaesthetist, facility and the implants themselves, since the implants are sometimes listed as a separate line. Custom implants made from a scan add to it. Because few surgeons anywhere do many of these, prices vary more by who is doing it than by the size of the implant.

Not in the quote are the vest, time off, and the cost of repositioning an implant that moves. Ask what the surgeon's policy is if that happens in the first year.

Choosing a pec implants surgeon

This is an uncommon operation, and uncommon among trans men most of all, so the question is not whether a surgeon can do it but how many they have done. The two numbers I would ask for are how many pec implant procedures they do a year, and how many of those have needed a second operation for a shifted implant. A surgeon who does a couple a year is learning on you.

In the photos, look at the lower edge of the pec and at the chest with the arms raised. That is where an implant shows if it is going to. Ask to see results at six months, not six weeks.

Ask for a lean chest like yours rather than a bodybuilder's, since a thick layer of muscle hides everything. The question that reveals experience is how they size the pocket to stop the implant moving. Someone who has thought about that has managed the problem before.

At the consultation

Ask "what happens if an implant moves?" You want a plan and a price, not reassurance. A surgeon who has repositioned one will tell you how they do it without being asked twice.

Frequently asked questions

Can I have pec implants at the same time as top surgery?

Most surgeons say no. They want a healed, settled chest before choosing the implant size, and that usually means at least a year. See combining.

Are they like breast implants?

No. Pec implants are solid, slightly flexible silicone rather than gel-filled, so they cannot rupture or leak. They sit under the muscle rather than over it. See how it's done.

Do I need to have had top surgery first?

Nearly always. The implant sits under a chest that is already flat, and the surgeon sizes it to the healed result, so on an unoperated chest there is nothing settled to size against. See who it's for.

Would fat grafting be better?

For a small, soft increase, possibly. It avoids an implant but part of the fat is reabsorbed and it does not give the defined lower edge. See alternatives.