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.
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.
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.
by Dr. Marc DuPéré