One of the most appealing characteristics of an athletic male body is a well-defined pectoral area (Fig. 9.1). The aesthetic standards for the male chest are strongly correlated with the shape and development of the pectoralis muscles. Abnormal fat deposition in the chest, gynecomastia, trauma, and congenital abnormalities distort the normal anatomy and are a common motivation to perform reshaping surgery. In addition, underdevelopment of the male chest musculature seems to be a result of modern urban lifestyle choices, including increased calorie intake, lack of physical activity, and resistance exercises. Most of the treatment options are focused on correcting the chest deficiencies and deformities
[1–3].

The ideal male chest is defined by the exposure of the surface anatomy, which is a reflection of the disposition and development of the pectoralis muscles. Although it is a reflection of the muscle mass itself, the surrounding areas must also be treated in order to produce optimal definition [4, 5].

The anatomy of the pectoral area is divided into specific zones to fulfill the goals of the technique (Fig. 9.2).

For years, implants have been considered the gold-standard method for treating pectoral deficiencies [2]. However, their shortcomings include expensive prostheses and potentially serious complications, including a poor aesthetic result and a “female”-like appearance. With fat grafting and superficial liposuction, we can produce superior results compared to these traditional methods, thus making it a good alternative for male chest reconstruction [6, 7]. For the purposes of fat grafting and planning, the pectoralis major is divided into upper and lower poles. Aesthetically, the upper pole should have a greater volume than the lower pole, due to the greater muscle mass, so most of the fat will be grafted to this region.

The anatomical features surrounding the pectoralis muscle are divided into five “negative spaces”: areas that should be concave in order to enhance the convexity of the pectoralis and surrounding muscles (Fig. 9.3).

The first negative space is a rhomboid between the inferior borders of the pectoralis major, the xiphoid process, and the origin of the rectus abdominis at the midline (interpectoral rhomboid).

The second area is a triangle defined by the pectoral line and the lateral border of the rectus abdominis (subpectoral triangle). This area must be treated aggressively with subdermal and intermediate liposuction. It also links the definition of the pectoralis muscles with definition of the abdomen.

The third area is the triangular area between the lateral border of the pectoralis major and the lateral border of the latissimus dorsi (pectoralis–latissimus triangle). Even though this is beyond the pectoral area, in the contouring process it is important to expand the concavity to this limit.

The fourth area is defined as the triangular area bordered by the clavicle, deltoid, and clavicular portion of the pectoralis major (subclavicular or deltopectoral triangle).

The fifth area is a horizontal line along the inferior border of the pectoralis major, usually 1 cm below the nipple level (pectoralis line). This represents a negative space that softens along the lateral border of the muscle toward the upper pole.

Finally, a triangular area defined by three points: the inferolateral corner of the pectoralis major, the medial point of the pectoral line, and the lateral insertion of the pectoralis major. This area is essentially the lower lateral pole of the pectoral area. Deep liposuction should be performed in this area in obese and gynecomastic patients, sometimes extending to the limits of the fatty tissue beyond the underlying pectoral muscle [5].