title: Dynamic-definition male pectoral reshaping and enhancement in slim, athletic, obese, and gynecomastic patients through selective fat removal and grafting.
abstract: BACKGROUND
  One of the most appealing characteristics of an athletic male body is a well-defined pectoral area. For decades, implants have been the gold standard method for the treatment of this area, but it is not suitable for every case. The goal was to design a mixed technique combining autologous fat extraction and grafting in an anatomically guided fashion to produce a highly athletic contour in the male pectoral.
  
  
  METHODS
  The patient criteria included a body mass index (BMI) lower than 30 kg/m(2), adequate skin tone, and general good health. A three-phase procedure was performed, beginning with infiltration of tumescent solution and followed by fragmentation of extra fat in an anatomic fashion using internal third-generation ultrasound; extraction that blends deep, intermediate, and superficial fat removal; and multilayer fat grafting in the pectoral area. In the presence of gynecomastia, a selective pull-through technique was used in an anatomic manner.
  
  
  RESULTS
  In a series of 154 consecutive male patients, the minor complications (n = 15) included asymmetries (n = 10) and residual gynecomastia (n = 5). The major complications (n = 3) included unilateral hematoma (n = 2), and abscess that required sonographic-guided removal (n = 1). An appealing muscular contour was produced in most patients, and the satisfaction rate was very high.
  
  
  CONCLUSIONS
  Implants are no longer the only option for defining and augmenting the male chest. Combining fat grafting in a multilayer fashion with precise anatomic fat and gland removal achieved a contoured and athletic male pectoral in a safe and reproducible manner.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article.
authors: Universidad de San Martin, Bogota, Colombia. alhoyos@gmail.com
authors: Alfredo
authors: A
authors: Hoyos
authors: Mauricio
authors: M
authors: Perez
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000293:Adolescent; D000328:Adult; D003357:Cosmetic Techniques; D006177:Gynecomastia / Q000601:surgery*; D006801:Humans; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013909:Thorax; D055815:Young Adult