Breast implants don't seem to be the territory of women any more in the US. Men too have begun to go for them more and more.
When weightlifting or dieting doesn't help, people of course go for steroids and human growth hormone. But when such strategies fail, they seem to opt for plastic surgery. It is a culture that enshrines physical perfection after all.
'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.'
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, reports the San Francisco Chronicle.
'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.
Pec implants were introduced 20 years ago, Dr. James J. Romano, a San Francisco plastic surgeon who performs 35 to 40 pec implant surgeries per year.
'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.'
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 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.'