Were You Told to "Wait and See" After Tearing Your Pec?
There Is a Better Option.
The pectoralis major is one of the most important muscles in the upper body — not only for function, but for appearance. It is the muscle men train hardest to develop, and its shape defines the contour of the chest. When it tears, the consequences are both physical and emotional: a visible deformity, a sunken hollow where the muscle once was, and a permanent loss of pressing strength that no amount of physical therapy can restore.
What makes the pectoralis major unusual — and what made it so difficult to treat surgically for decades — is its anatomy. Unlike most large muscles in the body, the pec has a very short tendon. This matters more than most patients realize, and it is worth understanding why.
When a tendon tears, surgeons can pass sutures directly through the tendon tissue. Tendon is dense, fibrous, and tough — it holds sutures extremely well. Muscle tissue, by contrast, is soft and friable. Sutures passed through muscle pull out. They have nothing to hold onto. This is not a technical failure; it is a biological reality.
Because the pectoralis major tendon is so short, many pec tears occur very close to — or within — the muscle belly itself, leaving surgeons with little or no tendon tissue through which to pass sutures. For decades, this was the reason pec tears were treated without surgery. The prevailing thinking was: if sutures won't hold in muscle, why operate?
The results of that approach were, by any measure, poor. Patients treated non-operatively were left with significant strength deficits, permanent chest asymmetry, and deep dissatisfaction — not only with their function, but with how they looked. For a muscle as visible and aesthetically significant as the pec, that cosmetic consequence is not a minor complaint.
Why Surgical Timing Matters
The window for straightforward primary repair is typically within 6 to 8 weeks of injury. During this period, the muscle is mobile, tissue quality is acceptable, and direct reattachment to the bone is achievable.
After that window, the tendon retracts, scars down, and loses elasticity. Chronic tears — those repaired more than 8 to 12 weeks after injury — require a more complex reconstruction. This is where augmentation becomes essential.
If you suffered a pec tear and were told to rest and wait, you may now be in a chronic state that requires a more sophisticated approach. Dr. Mirzayan has experience with both acute repair and chronic reconstruction, and will give you an honest assessment of where you stand and what your options are.
Dr. Mirzayan's Technique: Dermal Allograft Augmentation with Cortical Button Fixation
Faced with the fundamental problem of muscle that cannot reliably hold sutures, Dr. Mirzayan developed a solution: augment the repair using dermal allograft (donated human skin).
Dermal allograft is a biological scaffold derived from donor skin tissue. It is processed to remove cells while preserving the structural collagen matrix, leaving behind an extraordinarily strong material. You can pass a suture through dermal allograft and pull on it as hard as you want — it will not rip. The suture holds.
Dr. Mirzayan's technique involves placing the dermal allograft directly over the torn muscle end, then passing sutures through the graft and the underlying muscle simultaneously. The graft acts as a reinforcing bridge — it captures the muscle tissue within its collagen matrix and gives the sutures something strong to anchor into. The result is a repair construct that is robust, secure, and far more resistant to failure than sutures through muscle alone.
Three cortical buttons anchor the construct to the humerus, providing secure, low-profile fixation with excellent biomechanical performance.
Because of the strength of this augmented repair, patients are able to begin rehabilitation earlier than with traditional techniques. One of Dr. Mirzayan's patients returned to martial arts at three months after surgery — a return-to-sport timeline that would not have been possible with a conventional repair.
Putting It to the Test: The UCONN Biomechanics Study
Dr. Mirzayan did not rely on clinical impression alone. To validate his technique, he took his repair construct to the University of Connecticut biomechanics laboratory — one of the most respected facilities of its kind — and tested it under controlled conditions.
The results were striking. Repair without dermal allograft augmentation restored approximately 50% of normal pectoralis major tendon strength. With the dermal allograft added, the repair achieved 100% of normal tendon strength. The mode of failure in augmented repairs was cortical button pullout from bone — not suture pullout from muscle — indicating that the repair construct itself had exceeded the strength of the fixation hardware. In other words, the weakest link was no longer the repair — it was the bone.
These findings have been published in the peer-reviewed literature and the surgical technique has been described in a separate publication. The technique has also been demonstrated in a surgical video produced by Arthrex — one of the leading orthopedic surgical device companies in the world and a platform used by surgeons globally for continuing education.
Biomechanics study: Dermal Allograft-Augmented Pectoralis Major Repair — Biomechanical Analysis
Surgical technique publication: Pectoralis Major Tendon Repair with Acellular Dermal Allograft
Arthrex surgical technique video: Pectoralis Major Repair Augmented with Arthroflex Acellular Dermal Matrix
These findings are further supported by independent research: a separate investigation by other surgeons using dermal allograft augmentation for pectoralis major repair similarly demonstrated favorable patient outcomes, lending external validation to this approach beyond Dr. Mirzayan's own series. Independent outcomes study
Dr. Mirzayan's work on pectoralis major repair with dermal allograft augmentation was also featured in AAOS Now — the official clinical publication of the American Academy of Orthopaedic Surgeons — further establishing this technique as a subject of national academic recognition: Pectoralis Major Repair with Dermal Allograft Augmentation — AAOS Now
What to Expect: Diagnosis, Surgery, and Recovery
Diagnosis
MRI is the gold standard for evaluating pectoralis major tears. It allows precise characterization of the injury — partial versus complete, location of the tear, degree of retraction, and muscle quality. Physical examination alone can miss partial tears or underestimate the extent of injury. If you had an MRI performed elsewhere, Dr. Mirzayan will review your imaging personally — including during a virtual consultation if you are coming from out of state. The MRI should be of the chest wall and not a shoulder MRI.
Surgery
Pectoralis major repair is performed as an outpatient procedure under general anesthesia. The surgery typically takes 60 to 90 minutes. An incision is made over the front of the shoulder and upper arm to access the torn tendon. The tendon is mobilized, prepared, and reattached to its anatomic footprint on the humerus using cortical button fixation. Dr. Mirzayan performs his augmented technique by incorporating the dermal allograft into the construct at this stage. Patients go home the same day.
Recovery Timeline
The arm is placed in a sling for approximately 3-4 weeks to protect the repair. Gentle range-of-motion exercises begin early under the guidance of a physical therapist. Progressive strengthening begins around 3 months. Return to full training and heavy pressing typically occurs between 5 and 6 months, depending on the extent of injury. Most patients return to weightlifting, competitive sport, and physically demanding work at full capacity.
Coming from Las Vegas, Phoenix, or Out of State?
Dr. Mirzayan regularly treats patients from Las Vegas, Henderson, Phoenix, Scottsdale, and across the country. A pectoralis major tear is the kind of injury where the expertise of your surgeon — not the geography of your insurance network — determines your outcome.
If you carry a commercial insurance plan — Blue Cross Blue Shield PPO, Aetna, Cigna, United Healthcare, or a self-funded employer plan — you likely have out-of-network benefits that cover a substantial portion of the cost of surgery. Dr. Mirzayan's office will verify your coverage before you commit to anything. Many patients are surprised to find that the out-of-pocket cost of traveling to Los Angeles for the right surgeon is comparable to — or less than — what they would pay locally for an in-network provider.
Virtual consultations are available. Before you make any decisions, you can meet Dr. Mirzayan on video, review your MRI together, and determine whether making the trip is the right next step — before committing to travel or time off work.
Call (310) 746-5918 or contact us online to schedule your consultation.
Frequently Asked Questions
Why was pectoralis major surgery avoided for so long, and what changed?
For decades, surgeons hesitated to operate on pec tears because of a fundamental anatomical challenge: the pectoralis major has an unusually short tendon, and many tears occur close to or within the muscle belly itself. Sutures hold well in tendon but pull out of muscle tissue — making a secure repair seem impossible. The results of nonsurgical treatment were consistently poor, with patients left with permanent strength loss and visible chest asymmetry. Dr. Mirzayan developed a technique using dermal allograft — an extremely strong biological scaffold — to bridge this problem. By placing the graft over the torn muscle end and passing sutures through both simultaneously, he achieved a repair construct strong enough to withstand full rehabilitation loads. Biomechanical testing at the University of Connecticut confirmed the augmented repair restores 100% of normal pectoralis major tendon strength.
Can a pectoralis major tear heal on its own?
Partial tears in low-demand patients can sometimes improve with conservative treatment, though some degree of strength loss is common. Complete tears — where the tendon has fully detached from the bone — do not heal on their own. Without surgical repair, a complete tear results in a permanent strength deficit and visible asymmetry of the chest that does not resolve with time or therapy.
How do I know if my tear is complete or partial?
An MRI is necessary to determine the extent of your injury with certainty. Physical examination and history are helpful, but imaging is required for accurate diagnosis and surgical planning. If you had an MRI performed elsewhere, Dr. Mirzayan can review it during a virtual consultation before you travel.
Is it too late to have surgery if my injury is several months old?
Not necessarily. Chronic tears — those more than 8 to 12 weeks old — require a more complex approach, but they can still be successfully repaired. Dr. Mirzayan has experience with chronic pec major reconstruction, including the use of dermal allograft augmentation for cases where the native tissue alone is insufficient. The earlier you are evaluated, the more straightforward your options — but it is never too late!
Will I be able to return to heavy bench pressing after surgery?
The goal of surgical repair is full restoration of strength and function. Most of Dr. Mirzayan's patients return to weightlifting, including heavy pressing movements, between 5 and 6 months after surgery. One patient returned to martial arts at three months. Return-to-sport timelines vary depending on the extent of the injury, the technique used, and individual healing. Dr. Mirzayan will give you a realistic, personalized projection based on your specific case.
Can I see Dr. Mirzayan's surgical technique before deciding on surgery?
Yes. Dr. Mirzayan recorded a full surgical technique video demonstrating his dermal allograft-augmented pectoralis major repair, produced by Arthrex and available on their global surgical education platform. You can view it here: Arthrex Technique Video. Seeing the procedure before your consultation is entirely reasonable — Dr. Mirzayan encourages informed patients.
Do you offer virtual consultations for out-of-state patients?
Yes. You can submit your MRI and any prior records in advance, meet Dr. Mirzayan on video, and determine whether making the trip to Los Angeles is the right next step — before committing to travel or time off work. Call (310) 746-5918 to schedule.
Does being out-of-network mean I will pay full price out of pocket?
Not necessarily. Many patients with commercial insurance — especially those with PPO plans or self-funded employer plans — have strong out-of-network benefits. Dr. Mirzayan's office will verify your coverage before your consultation so you have a clear picture of what to expect. Many patients are surprised by how affordable the right care can be.
About Dr. Raffy Mirzayan
Dr. Raffy Mirzayan, MD is a double-board certified orthopedic sports medicine surgeon and a pioneer in the surgical treatment of pectoralis major tears. Faced with a problem that kept surgeons from operating on pec tears for decades — muscle tissue that cannot reliably hold sutures — Dr. Mirzayan developed an augmented repair technique using dermal allograft and cortical button fixation that fundamentally changed what is achievable with this injury. He has published his biomechanical findings and his surgical technique in the peer-reviewed literature, demonstrated the procedure in a surgical technique video produced by Arthrex, and has now performed this technique in 30 patients — with outcomes that include return to martial arts at three months after surgery. For weightlifters, strength athletes, and active adults who have torn their pec and want the strongest possible repair and the fastest possible return to training, Dr. Mirzayan offers a level of expertise and a published track record that is unmatched. He practices at DOCS Health in Los Angeles, serves as a Clinical Professor of Orthopaedic Surgery at USC, and welcomes patients from across the United States, including Las Vegas, Phoenix, and Scottsdale, for virtual consultations and in-person care.
DOCS Health | 8436 W 3rd St #800, Los Angeles, CA 90048 | (310) 746-5918 | raffymirzayan.com
