Pectoralis major repair is an operation to reattach a torn pectoralis major tendon to the humerus. Rupture typically occurs during heavy bench pressing or other forceful horizontal adduction activities.
An incision is made in the anterior axillary fold (front of the armpit). The retracted tendon stump is identified and mobilised. The humeral insertion site is prepared. The tendon is reattached using suture anchors or through bone tunnels. For chronic ruptures, a tendon graft may be needed. The operation takes one to one and a half hours.
Surgical repair is recommended for complete pectoralis major ruptures in active patients, particularly those involved in strength training, contact sports, or manual labour. Without repair, there is permanent loss of adduction and internal rotation strength and a visible cosmetic deformity.
Physiotherapy and acceptance of the strength deficit and cosmetic deformity. Non-operative management is reasonable for partial tears, elderly patients, or those with low physical demands.
MRI or ultrasound to confirm the tear and assess retraction. Surgery is ideally performed within six weeks of injury. Chronic repairs (beyond three months) are more complex and outcomes are less predictable.
Restoration of pectoralis strength to approximately 90% of normal. Correction of the cosmetic deformity. Most patients return to full bench pressing at six to nine months.
Soreness at the repair site for several weeks.
Visible scar in the axillary fold.
Minor strength deficit compared to the uninjured side.
The repair may fail, particularly with premature heavy loading. Risk approximately 5%.
Lateral pectoral nerve or medial pectoral nerve.
Wound infection.
Blood collection in the chest wall.
Shoulder stiffness from immobilisation.
General anaesthesia. Beach-chair position.
Sling for four to six weeks. No bench pressing or heavy pushing for four months. Graduated strengthening from six weeks. Light bench pressing at four months. Full bench pressing at six to nine months.
Reviews at two weeks, six weeks, and three months.
Pectoralis major ruptures almost always occur during heavy eccentric loading — typically the lowering phase of a bench press with heavy weight. Risk factors include anabolic steroid use (which weakens tendons), prior corticosteroid injection, and fluoroquinolone antibiotics.
Yes — most patients return to full bench pressing at six to nine months. Starting with light weight and gradually progressing under physiotherapy guidance is essential.