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More men turning to implants for chests of gold

The poster boy in the Abercrombie & Fitch window looks like Huck Finn, if Huck were genetically engineered with "Say howdy!" nipples and perfectly symmetrical, squared-off pecs. In "300," last year's cartoonish gladiator epic, the actors looked so exaggerated, so cyborg-like in their soccer-star thighs, ripped abs and shield-like chests, that they all seemed airbrushed.

The list goes on: the ultra-reconditioned Brad Pitt in "Troy," Daniel Craig in tight trunks in "Casino Royale," that buck-naked beauty in the steamy Dolce & Gabbana magazine ad.

Is anybody just average-looking anymore? In a culture that enshrines physical perfection and makes the Philip Seymour Hoffmans among us feel homely and inadequate, more men are attempting impossible goals. Most do it through weightlifting and dieting. Some men are driven to steroids, human growth hormone and plastic surgery if those other methods fail.

"Location is everything," says Bill Hayes, a lifelong bodybuilder and writer on health and medical issues ("The Anatomist"). "And in the landscape of the body, the chest is prime territory. Think about it: It's at the top of the trunk; it protects and covers the heart and lungs. It's a great spot for a head to rest on."

When weightlifting and exercise don’t produce results, some men compensate with cosmetic surgery. Pectoral implants, although still a niche product, are growing in popularity: 409 procedures were performed in 2006, according to the American Society of Plastic Surgeons, a 99 percent increase over the year before. There's a stigma attached to them - the feeling that men who go that route are lazy or excessively vain - but those who buy the implants contend that the psychological benefits are substantial.

"It's such a confidence booster," says one San Francisco massage therapist who got the implants two years ago as a 40th birthday gift to himself. "I walk a little taller now. And of course you want to buy every tight white T-shirt. It's crazy!"

Anthony Durante, a San Francisco personal trainer for 25 years, says well-defined pecs project "power, strength, health, virility.

"A guy with a great chest looks like a warrior, wearing armor for battle. Nothing can penetrate that hull."

Among his clients, Durante says, "the chest is usually their first concern." "Every time a man looks in a mirror," adds Hayes, "whether shaving or at the gym, he sees his chest. So naturally it becomes a focus of his attention or even obsession - as opposed to back muscles, which generally go unseen and are often ignored entirely."

For most of the 20th century, weightlifting and the "300" body ideal were marginalized, regarded as fetishy by mainstream standards. Consider 1940s movie stars like Humphrey Bogart or Cary Grant, or '60s icons Steve McQueen and Paul Newman: They had looks and charisma; they were trim. But none had the Vin Diesel superhero physique or overdeveloped chest of today's cultural ideal.

"It was sometime in the '80s when it sort of all began for men," says Edisol W. Dotson, author "Behold the Man: The Hype and Selling of Male Beauty in Media and Culture" (Haworth Press, 1999). "You saw it in the 'Terminator' films and big action adventures. The early Batman films."
Pec implant surgery starts at about $7,000. Beverly Hills surgeon Adrien Aiache, who performs about three dozen procedures per year, says he charges $9,000. The massage therapist, who asked not to be identified because he is sensitive about appearing overly vain, says he paid $12,000 and has no regrets. "No one's ever said, not once, 'Are those implants?' " he claims - including the men with whom he's been intimate.

He'd thought about getting new pecs for years, but balked because of bad implants he'd seen.
"There was this one guy at a bar in the Castro, years and years ago," he said. "Oh my God, it was so obnoxiously fake. Like a Pamela Anderson kind of thing. I would never want to be that obvious."

The massage therapist shopped around, researched the pros and cons, and chose Dr. James J. Romano, a San Francisco plastic surgeon who performs 35 to 40 pec implant surgeries per year. The procedure is expensive, in part, Romano says, because the implants, manufactured by Allied Biomedicals in Ventura, cost $1,600 for a pair.

"People buy cars, right?" said the massage therapist. "People buy property. I thought, 'I'll buy a set of pecs!' Like shopping at Crate & Barrel. 'I'll take that one.' " The implants come in two shapes and five sizes, and are made from silicone - not the soft liquid gel in breast implants, but a semi-solid substance. They're slightly more firm than the consistency of a Gummy Bear.

"My close friends asked me, 'Weren't you frightened going in for that kind of surgery?' I said, 'Oh, my God, I could walk out on Powell and get hit by one of those crazy cabs.' Never postpone joy is, like, my big mantra."

Pec implants were introduced 20 years ago, Romano says, although as recently as 2000, the statistics weren't recorded by the American Society of Plastic Surgeons.

"It's a cult following, almost, although it's growing because of the media and the Internet." For the most part it's cosmetic, but in some cases men seek implants because of congenital deformities: They're missing ribs or a pectoral muscle on one side, or there's a natural concavity they want to correct.

During the operation, Romano says, "I make an incision high up in the armpit in the hair-bearing region. It's about three fingers wide. Then the space is made under the muscle in what we call a 'free area' in surgery: free of nerves, free of blood vessels."

Romano folds the implant in half and positions it between the pectoral muscles, sews up the incision and then repeats the process on the other side of the chest. Recovery is "mostly quite comfortable," Romano says, "and is mostly complete within two weeks."

When the massage therapist awoke in the recovery room, he remembers, "I felt like someone had beat the crap out of me. Thank God there's Demerol. It was hard for me to even get up. I was so heavy and taking all these pain pills to dull the throbbing. ... I was kind of scared. And being a massage therapist I thought, 'Oh, my God, what if I can't use my arms?' (But) I have full range of motion and I'm strong. You would just never know!"

Romano says he screens patients carefully to make sure their expectations are realistic.

"Some men come in and ask for it, and either don't have the anatomy that will allow me to do it and look good, or they want something that is too big or out of proportion. I don't take all comers."

The risks of the procedure include a possible migration. "(The implant) can move a little bit. I tell the patients, 'You're going to feel the edges sometimes when you're lifting or involved in the extreme ranges of motion or other activities. It's never going to be like your God-given chest.' But that's the art and science of putting in pectoral implants. You've got to match them to the body."

Even today, men form a tiny minority of plastic surgery patients. In 2006, there were 11.5 million cosmetic procedures performed in the United States, 1 million of which were on men. Nose reshaping was the most popular procedure for men in 2006, followed by eyelid surgery, liposuction, hair transplant and gynecoplastia - the removal of breast tissue caused by an estrogen imbalance.

So why, given the obsession for the perfect chest, haven't pec implants been more popular? One reason is that pectoral muscles are large, and with diligent workouts they can usually be developed. Women, by contrast, don't have that option when larger breasts are the goal.
Aiache of Beverly Hills thinks homophobia is also a factor.

"A lot of people with pectoral implants are gay, and many physicians don't want to take care of the gay population in general," he says. In his own practice, Aiache says, 80 percent of pectoral implant recipients are gay.

Pec implants were introduced 20 years ago, Romano says, although as recently as 2000, the statistics weren't recorded by the American Society of Plastic Surgeons.

Romano says he screens patients carefully to make sure their expectations are realistic.

"Some men come in and ask for it, and either don't have the anatomy that will allow me to do it and look good, or they want something that is too big or out of proportion. I don't take all comers."

"Pec implants have much more shame attached to them than, say, breast implants," says Durante. "Breast implants are so widely known that even though they are 'spotted' or 'suspected,' they are part of the cultural landscape. There is also a vanity attached to pec implants: They may be considered a character flaw (in the man). He's seen as weak."

San Francisco plastic surgeon James Anthony doesn't perform pec implants surgery, in part because of the risks. "It's possible to have malpositioning of the implant, where it's in the wrong spot and one's a little higher than the other. It also has a chance of infection, but any foreign body has a chance of infection. And then the other thing you have to be careful of is not to damage the nerve that goes to the nipple. Because otherwise you get numbness, which is a consideration for some men."

Opinions differ on the attractiveness of pec implants. Durante says the majority look obvious "because they don't match their shoulder and arm development - not unlike a woman whose breast implants are too big." Hayes said he finds implants "rigid and plasticky."

Maura Armstrong Morgan, an echocardiographer with Golden Gate Radiology in San Francisco, has her own problem with implants, pectoral or breast alike. "You can't see through them with sonar. They block the sound waves, so you're unable to obtain useable images," she said. "Normally, you shoot between the ribs and get this wonderful image of a beating heart."

With implants, "you get this big, egg-shaped void. ... So I have to shoot obliquely. I had one patient doing everything but standing on their head to get a picture of their heart."

Before he had the pectoral implants, the massage therapist said his chest was "OK." "But I just wanted it to be more. The whole peacock image, if you like. You want a bigger spread of feathers. ... It's a bit of a magnet."

Some people understand his decision to get the implants, and some people don't. "There's a community out there that says, 'Oh, God, why would you do plastic surgery?' And I'm like, whatever. 'Why do people eat at McDonald's every day?' You could go on and on forever, right?"

Leonard Kashio uses only POMEGA5 products