A story of Pectus

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Custom-made implant for Pectus Excavatum

Congenital anomaly or malformation of the pectus (i.e. chest) is relatively common and this condition may present in a wide variation of severity.  Being one of Canada top body implants experts, I very commonly see patients with one of those anomalies coming to my plastic surgery office in Toronto and Richmond Hill.

The chest wall refers to the ribs and the sternum (aka chest bone).  During its development, the front part of the chest wall can become too deep, i.e. excavated, hence the term pectus excavatum.

At the other end of the spectrum for chest anomaly is a condition characterized by a raised mid-chest area, analogous to the keel or hull of a boat, known as ‘carinata’ in latin, hence, pectus carinatum.  It is also referred to as “pigeon’s chest” or ‘opera-singer’s chest’ or ‘barrel chest’.

Very severe pectus excavatum can interfere with the breathing and this serious condition would normally be corrected surgically early during development by the thoracic pediatric surgeons.  The ‘Ravitch’ and ‘Nuss’ procedure are such examples.

Less severe conditions do not require treatment during childhood and adolescence but may become an aesthetic concern over time.  Hence my involvement as Toronto aesthetic plastic surgeon.

Various treatment options exist depending on the anatomic manifestation and severity of the pectus excavatum deformity and the patient’s expectations.  Cost and recovery for the correction of pectus excavatum will also vary according to the chosen technique.

Bilateral pectoral augmentation with implants can be sometimes an option for mild pectus excavatum.  Those implants are made of soft silicone polymer, cushion-like.  The material is similar to buttock and calf implants.

Another option for correction for correction of pectus excavatum is fat grafting; fat is taken from the patient from another location, such as the abdomen, legs, love handles, etc., centrifuged (Coleman’s technique of fat transfer) and transferred delicately into the soft tissue defect.  This is a similar technique as seen in facial fat transfer and with the Brazilian Butt lift technique, but in a smaller scale.  This technique is very limited for that location as the thickness of soft tissue is very restrictive.

My most common option for pectus excavatum correction however is a custom-made implant.  This is where the ultimate meaning of plastic surgery comes handy: plastikos or plasticus for ‘the ability to mold, shape and form’.  This custom-made implant require a first visit where the defect is temporarily corrected with the moulding of plasticine-like material by the plastic surgeon to fit into the patient’s concavity (defect).  Patient also gets to approve the molding.  Once ‘dried’, the mold is sent back to USA for the final implant to be made, cured and sterilized, after which it is sent back to Toronto for implantation.

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Front view custom-made implant for pectus excavatum

 

The implantation process for pectus excavatum is done either under intravenous deep sedation or general anesthesia in our accredited surgical centre in Toronto.  A 4-5cm incision is required and placed in the inverted-V area, where the chest bone meets the ribs and abdomen, in the midline.

Because the custom-made chest implant is shaped to be very thin at the edges, the possibility to see the edges post-operatively is small.  Shifting or displacement of the chest implant is also unlikely once the body has formed a capsule and secured the implant after the first 6-8 weeks post-procedure.

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Side view of a custom-made implant for pectus excavatum

 

The aesthetic correction of any pectus excavatum deformity does restore patients’ confidence and self-esteem.  It is a very satisfactory procedure for both myself and my patients in Toronto.

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Dr. DuPere’s patient with Pectus excavatum

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Dr. DuPere’s patient with pectus excavatum

 

by Dr. Marc DuPéré

46 Responses to A story of Pectus

  1. Maria Velez says:

    Hello,

    I’m a 20 year old female with Pectus Excavatum in Colombia. What company in the US makes these implants? What material are they? My plastic surgeon has had issues finding a company that will make a custom-made implant.

    Thank you in advance,
    Maria Velez.

  2. Andrew Lightle says:

    Approximately how much would the surgery cost? Does the implant go underneath the pectoral muscles? Also, should a patient wear a brace or exercise to correct flared ribs after the procedure or would that modify the chest causing the implant to become visible?

    • Dr Marc DuPéré says:

      Good morning Andrew. Pectus Excavatum correction is a specialty of mine. I will email you directly some details.

      Best,
      Dr. DuPere

      • Shayna says:

        I have pectus excavatum on only one side (right) and being female this makes bras and shirts and basically everything a challenge. I am looking into treatment now but I don’t think it is severe enough for a miss procedure to be covered by insurance and I’m not sure I would want something so drastic. I’ve been reading that this might be a good alternative. Could you also email me with info and cost!

          • Dr. Marc DuPéré says:

            Hi Shayna, I do not perform the NUSS procedure – it is usually done by Thoracic surgeon. But I often treat Pectus Excavatum with custom-made implants (or breast implants sometimes) for failed NUSS procedures and for chest anomalies not serious enough to require the more invasive and serious NUSS procedure (often done for people with difficulty breathing).

            But I would be happy to meet with you to discuss implants.

            Best regards,

            Dr. DuPere 416.929.9800

          • Dr. Marc DuPéré says:

            Hi Shayna, I do not perform the NUSS procedure – it is usually done by Thoracic surgeon. But I often treat Pectus Excavatum with custom-made implants (or breast implants sometimes) for failed NUSS procedures and for chest anomalies not serious enough to require the more invasive and serious NUSS procedure (often done for people with difficulty breathing).

            But I would be happy to meet with you to discuss implants.

            Best regards,

            Dr. DuPere 416.929.9800

        • Dr. Marc DuPéré says:

          Hi Shayna, I do not perform the NUSS procedure – it is usually done by Thoracic surgeon. But I often treat Pectus Excavatum with custom-made implants (or breast implants sometimes) for failed NUSS procedures and for chest anomalies not serious enough to require the more invasive and serious NUSS procedure (often done for people with difficulty breathing).

          I will email more information in a few minutes.

          I would be happy to meet with you to discuss.

          Best regards,

          Dr. DuPere 416.929.9800

  3. Samantha says:

    Do you also specialize in pectus carinatum? I would love to get breast augmentation to make it less noticeable and boost my self esteem. But would really hope for someone familiar with doing it.
    Thanks please email me.

    • Dr Marc DuPéré says:

      Hi Raquel, yes this can be done on ladies! I will email you directly for more information and come and visit us for a consultation – 416-929-9800

      Best, Dr. DuPere drdupereATvisageclinic.com

    • Dr Marc DuPéré says:

      Good morning Shannon, OHIP in Ontario usually only covers for “functional” problems. The NUSS procedure is covered for those with pectus excavatum and breathing difficulty. Implant surgery is not done for function and is not usually covered. Please let me know if you want more information on my custom-made implants for pectus excavatum – it is a specialty of mine! and email me at: drdupereATvisageclinic.com. Dr. DuPere

  4. Ro says:

    Hello Dr. DuPéré,

    I was wondering if you could send me further information on how this surgery would work on a female and if it could potentially change the positioning of breasts on the chest wall without a BA?

    Thank you.

    • Dr. Marc DuPéré says:

      Hi Ro,

      It might be possible but I would need to see some pictures, or best, to meet with you.

      My email is: drdupereATvisageclinic.com

  5. JOanne says:

    Hello,
    Are you equally skilled in breast augmentation for this condition? My 21 yr old daughter had the nuss procedure at 14 yrs, and has experienced caving in, although not quite as severe. She is extremely small breasted, and what little is there, appear oddly shaped and they sit quite low on her chest. Ribs protrude further than her breasts, pectoral muscles for her workouts protrude further than her bust also. She feels quite depressed about the end result. I understand that augmentation must be done by a skilled surgeon knowledgeable about this deformity. Is any of this type of correction covered, and if not what is the cost?

    • Dr. Marc DuPéré says:

      Good morning Joanne,

      I do have several years of experience and would gladly see your daughter for an assessment. Only then I would be able to provide a quote. I sometimes use regular breast implants (sometimes of different sizes), sometimes a custom-made implant, sometimes a combination of both. Fat grafting is also sometimes an adjunct procedure. Prices vary depending on what will be done.

      Best is to contact my assistants at 416-929-9800 to schedule a consultation.

      Best,

      Dr DuPere

  6. Sandra says:

    Hello,

    I am curious to know if you have treated any males with Poland Syndrome? I understand there is a customized implant that is available (easier to access in the US), that possibly creates a more natural outcome. I believe a moulage is taken of the chest with the missing pectoral and the implant is created using that.

    We live in BC and are having one heck of a time trying to find a surgeon with experience with this surgery and access to this material. Curious if you have used this before. We have located a surgeon in California but would rather stay in Canada as MSP has agreed to pay for it.

    Thanks in advance
    Sandra

  7. Thomas T Tornow says:

    I am interested in the implant. It seems like the least intrusive solution for what, in my case, is a strictly cosmetic situation.

  8. Matthew Burton says:

    Hello! I’m interested with the Pectus Excavatum correction, implant surgery. It’s purely for cosmetic reasons. Also I have a physical job so I was curious on what the recovery time would be like?

    Thank you Sir,

    Matthew

  9. Kay says:

    Hi, I was wondering if you could email me with a price range for how much the cosmetic implant procedure would cost? I know you’d have to do an assessment for a quote but a price range would really clarify if this is possible for me or not.

    Thanks!

  10. Jan says:

    Hi. I am just curious about your procedure. I am not into the Nuss procedure due to its intrusive nature, but I am not sure if your implants will be a more viable option, since it’s only good for mild version. My GP said that mine is not severe enough for it to affect my breathing, but it’s visibly concave in. I am based in Australia and would like to find out more.

    • Dr. Marc DuPéré says:

      Hi Jan, I will email you in greater details but custom-made implants can be made in any size so it will work for any concavity/depression. I may mention mild to moderate only because the severe ones are usually accompanied with breathing problems. Sorry for the confusion! We do offer SKYPE-Camera consultation if you wanted to talk about this further! Kind regards, Dr. DuPéré

    • Dr. Marc DuPéré says:

      Thank you for your question. The answer is “most likely feasible”. I would need to know more about your condition to answer definitively. The complex part of the reconstruction in pectus excavatum is the making of the implant. The surgery itself is almost bloodless. I use local anesthetics with epinephrine which decreases the bleeding. I also do all the dissection with cautery, which seal the blood vessels as I am working. The good thing is that there are no large blood vessels in this location. Let me know if you need more information! Dr. D.

  11. Sylvain Labrie says:

    Hello Dr. Dupéré, my son have a pectus excavatum, I would like to know if it’s possible to perform this operation on a patient of 16 year old. Thanks

    • Dr. Marc DuPéré says:

      Bonsoir Sylvain, I just emailed you some information. As for age 16… there might still be a slight growth over the next 2-3 years and could in theory affect the implant I would craft. Otherwise, I would be happy to meet you and your son when ready to discuss. Kind regards, MD

  12. Jason says:

    Hello Dr. DuPéré. I am a 43 year old man with PE. Could you send me info regarding the cost of the corrective procedure(s)?

    Many thanks.

  13. Rio says:

    Hello Doctor.
    I am 39 y.o male from Vancouver with chest PE. Could I get more information regarding the implant include cost?

    • Dr. Marc DuPéré says:

      Good afternoon and thank you for your request. You will be pleased to know that I have many patients in British-Columbia who came for their pectus excavatum surgery here in Toronto. We do offer SKYPE-camera as a first for patient who live far away. I will email you more details in a few minutes. I look forward to meeting you, Kind regards, Dr. D.

  14. Sebastien says:

    Hi, I was wondering if you could email me with a price range for how much the cosmetic implant procedure would cost?

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