BACKGROUND: Pectoralis major (PM) injuries are rare, primarily occurring in males during athletic activity. In the current literature, these injuries have not been well described in National Football League (NFL) athletes. HYPOTHESIS: The incidence of PM injuries will be low in NFL athletes, with athletes missing significantly more time after injuries requiring operative management. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: All documented PM injuries were retrospectively analyzed using the NFL Injury Surveillance System over a 15-season period. The data were analyzed by season, session, position, activity, and contact type at the time of injury. Additionally, the incidence, treatment, and days missed as a result of injury were assessed. RESULTS: Over 15 consecutive seasons, there were a total of 211 PM injuries. Of these injuries, 132 were classified as strains and 79 as ruptures. The incidence of strains was 0.41 per 10,000 athlete-exposures, compared with 0.25 per 10,0000 athlete-exposures for ruptures (P < 0.01). Players with PM ruptures treated operatively missed significantly more days than players treated nonoperatively (146.7 +/- 55.0 vs 77.2 +/- 72.9; P < 0.01). CONCLUSION: NFL athletes miss significantly more time after operative compared with nonoperative management of PM ruptures. CLINICAL RELEVANCE: PM injuries are rare, with the current literature lacking description of these injuries in NFL athletes. The paucity of data limits physicians from providing adequate counseling and expectations for athletes with this injury. This research represents the largest study assessing PM injuries in NFL athletes.