Article Published In: The American Journal of Cosmetic Surgery Vol. 23, No. 1, 2006

Nikolas V. Chugay, DO; Joseph Racanelli, DO; John Hsu, DO; Paul N. Chugay, MD

Introduction: This article describes the surgical procedure used to implant a bicipital prosthesis with little injury to surrounding anatomic structures into the arm of a 32-year old man who desired greater upper body symmetry.

Materials and Methods: The solid silicone implant used in this procedure was initially developed for reconstruction of the upper extremity after traumatic injury to the region of the biceps or excessive resection of a tumor from the area. A custom bicipital implant is inserted below the fascia into a submuscular pocket. Meticulous hemostasis is achieved by electrocautery to prevent postoperative complications. The biceps muscle is then reapproximated with 3-0 Vicryl sutures, with the knots buried very deep. Afterwards, the bicipital fascia is repaired with 4-0 Vicryl suture.

Results: Aesthetically pleasing and dramatic results can be obtained from this procedure.

Discussion: Bicipital augmentation surgery is a relatively straightforward procedure that affords great results. The vast majority of dissection during the procedure is blunt with natural tissue planes, thus preventing any damage to vital structures in the upper arm. Regarding potential complications that may be encountered, one should be mindful of the location of the lateral antibrachial cutaneous nerve to avoid loss of sensation in the lateral aspect of the forearm. Prudent dissection of the pocket for the implant is essential for optimal cosmesis and to prevent implant malposition. Multilayer closure with absorbable monofilament suture has proven beneficial in avoiding hypertrophic postoperative scars.