Contour restoration of the upper limb using solid silicone implants.
Augmentation of the upper limb, except for the pectoralis major using pectoral implants, has been somewhat taboo for plastic surgeons. Deformities of the upper limb and muscular deficiencies, however, are aesthetically unattractive or result in unacceptable asymmetries. The following implants have been used for reconstruction of the upper limb after trauma: deltoid, triceps, and biceps. Following the dictum that the implant needs to be placed beneath the muscle (i.e., on the humerus for the deltoid and the triceps, and underneath the brachialis for the biceps muscles), these implants are deep and act as spacers affording the establishment of more volume and symmetry. Access incisions make use of incisions previously placed for the repair of previous trauma, fractures of the upper limb, or the repair of muscle. Most aesthetic surgeons are not familiar with this anatomy, and revision for the morbid anatomy of the upper limb is important. Familiarity with the major nerves of the upper limb is paramount, particularly familiarity with the radial, ulnar, median, and circumflex humeral nerves.