Where Is The Best Location for Deltoid Implants?

Q: Dr. Eppley, I am interested in getting deltoid implants. I am a 36 years old male and I have very short clavicles and a larger than average head to make my shoulders appear even more narrow. I have read a response to a deltoid implant question it made me come up with a few questions.

1. The response stated that the implants can be place in a intramuscular location. Does that apply to an implant for both lateral and posterior deltoid heads? If not, what type of deltoid implant can be placed in the muscle?

2. How much actual width could be added using the largest implant possible without effecting practical functions (such as lifting the arms sideways)? I attached a picture of my narrow shoulder along with a photo-reference of a look I’m going for. I’ve provided of a picture of the look I’m trying to achieve with surgery. The red area is what would be the ideal mass added with an implant. Would this be possible?

A: When it comes to deltoid implants, an understanding of the anatomy is important when considering implant placement. The deltoid muscle is a broad muscle that creates the rounded contour of the shoulder. While it technically has three sections or muscle bellies (anterior, central and posterior), it is best to surgically think if it as single muscle belly as they are difficult to separate. The muscle is also enveloped by a fascial lining that is most manifest on its outer surface. Thus implants can be placed either submuscular (under the muscle) or subfascial. (above the muscle but under the fascia)

When considering where to place a deltoid implant, one has to take into consideration the movement of the muscle and the arm. As the arm lifts away from the body, the deltoid muscle contracts and becomes shorter. There is the risk, therefore, that a submuscular implant placed directly under the central belly of the muscle could interfere with arm motion. This would be less true for a very small implant or one that is placed closer to the front or back edge of muscle, but this then would not have much of a visible effect as you desire. This makes the subfascial location preferred in most cases.

Lastly there is the issue of incision location to place a deltoid implant. This is almost always best done on the back side of the arm where it meeds the trunk, keeping any scarring in the least visible location.

Your photo reference indicates a result that probably can not be achieved. Maybe half to three-quarters of that amount of shoulder augmentation is more realistic. Think of adding about 1 to 1.5cms width per side.

Dr. Barry Eppley

Indianapolis, Indiana