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Darryl J Hodgkinson, Commentary on: Biceps Augmentation Using Solid Silicone Implants, Aesthetic Surgery Journal, Volume 38, Issue 4, April 2018, Pages 409–410, https://doi.org/10.1093/asj/sjx188
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Extract
The author presents the largest series of biceps augmentation of 21 males over a five-year period.1 The augmentation was via a solid silicone implant placed either submuscularly or subfascially in the upper arm. The mean age was 42.6 years. The majority of patients wanted an increase in size of the biceps for purely aesthetic reasons (16), however five patients received augmentation for contour restoration of a ruptured biceps muscle. The majority (15), received a submuscular implant whilst 8 received a subfascial implant. Complications were high (48%) with a reoperation rate of 23.8%. There was a higher rate of implant malposition in the subfascial group. Being a new area of interest and endeavor, it is encouraging that the author is honest about the problems with this procedure.
The author used an axillary approach which is seen in the author’s Figure 3B and shows the scar just distal to the axilla on the arm, although the incision is less obvious in the remaining two images (Figures 1D and 2D). The biceps rupture patients, if there has been a previous attempt to repair with an incision, can be operated on using access up to the submuscular area utilizing the previous scar. I generally use a horizontal scar in the medial aspect of the arm but limit its length putting it in the natural groove used for a brachioplasty. There is less likelihood to damage branches of cutaneous branches from the brachial plexus as they run horizontal along the line. I would be concerned that dissection through a horizontal incision in the proximal upper arm might cause traction and possibly damage these horizontally running cutaneous nerves. A subfascial approach gives more “show” of the implant.
