Pec Major Tears: Surgery or Not?

Tearing your pectoralis major is dramatic.
It’s usually a loud pop during a heavy bench press or a powerful action like bowling or tackling, followed by immediate pain, bruising in the upper arm, and a noticeable dent where your vast chest muscle used to be.

For years, the accepted wisdom has been simple: “You tear it, you fix it, with surgery.” How well does this viewpoint correspond to the facts?

What actually happens

The pectoralis major tendon, the thick cord connecting your chest muscle to your upper arm, can tear right off the bone (rarely the whole thing, but bits of it). Most tears happen when the arm is stretched back and loaded, especially during the eccentric (downward) phase of a bench press. The muscle recoils, leaving a visible deformity and a sudden loss of power in pushing movements.

What the evidence says

A 2020 systematic review and meta-analysis by Bodendorfer et al. pooled 23 studies (664 injuries) to compare surgical repair and non-surgical rehabilitation (1).

Here’s the short version:

So, what should you do?

Both options work, the difference is what you want out of your recovery.

• Surgery offers the best chance to restore full strength and chest symmetry, but it involves longer rehab and a small risk of complications.
• Non-surgical rehab often leads to full pain-free function and return to work or sport, but the cosmetic defect and some strength deficits remain.

In practice, that means:

• If you’re a lifter, contact athlete, shirtless model, or manual worker, surgery makes sense.
• If you’re recreational, pain-free, and happy with function, rehab alone may be completely fine.

There’s no single “right” path.
The best approach is the one that matches your goals, tolerance for risk, and what you value: strength, appearance, or simply getting back to living.
And for the record: I tore my pec fast bowling in cricket in my early 30s. I went the non-surgical route, and currently have no pain, full function, just a visible reminder that in the form of a chest defect of a live fully lived.

Talk to your physio, surgeon, or whoever you trust to develop a fully informed view of what is the best path forward for you.

References

1. Bodendorfer BM, McCormick BP, Wang DX, Looney AM, Conroy CM, Fryar CM, et al. Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment. Orthop J Sports Med. 2020;8(2):2325967119900813.