Choosing an Implant Size for Someone with Pigeon Chest?

I have pigeon breast, am 5'5" and weigh 110 lbs, I wear size 32C but would like implants to improve the shape of my breast. The first surgeon recommended 400 cc stating that pigoen breast patients need a larger implant, the second surgeon wants to do 240cc which he stated would take me up to a full D cup which would be the max I would want to be. I am concerned since they are recommending very diffent sizes. How do I know what is the right decision?

Doctor Answers (19)

Breast Implants for Pigeon Chest Shape

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Pigeon Chest  also called pectus cariniatum,  require a plastic surgeon with great experience to get the best response. If you have two conflicting opinions you might want a third consultation. 
Even without  a "pigeon chest" shape, it is very difficult to determine the exact size and shape of implant that you will need without an examination by a board certified plastic surgeon. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be tough to answer your question. For example your native base width of your breast will determine in many cases the maximal volume per implant profile that you can accommodate. To illustrate a 100 cc difference may make a significant difference with a narrow base width, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Additional critical decisions will also be made by your plastic surgeon such as: whether your implants will be above or below your pectoralis muscle. These choices are recommended to you based on the look you desire, the amount of sagging you may have, and other deciding factors. I always find it helpful for patients to bring in photos from my or other plastic surgeons’ websites to illustrate what they would like to look like. I bring these photos to the operating room for reference during surgery so that I have the advantage of “seeing through my patient’s eyes” to achieve their wishes.
I personally order more than one set of implant sizes and use sterile sizers placed in the pocket during surgery to know in advance exactly which implant would work best for you. Software morphing programs can be helpful in some but not all cases (e.g. doesn't work well in my experience with existing implants, sagging or asymmetric breasts).
My advice is to accept advice from your board certified plastic surgeon after a formal consultation and examination with measurements.. If still confused don't hesitate to get a second opinion.


Orange County Plastic Surgeon
5.0 out of 5 stars 45 reviews

Implant size selection with chest wall anomalies

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Its difficult to answer your question or give any recommendations without a formal physical exam.  I consider two factors when selecting implants for my patients:

1.Dimensional planning
2.Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look.  If you have decided on saline implants, then based on the gel sizer you select, we can guide you to the saline implant that achieves a similar look.
Hope this helps.
Dr. Basu
Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 117 reviews

Choosing implant size can be tricky

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Placing a breast implant to give a patient the look she wants can be tricky.  There is always some asymmetry to the breast/chest and everyone's chest cavity is shaped differently.

Pectus carinatum (pigeon breast) is a deformity of the chest wall when the sternum (breast bone) is protruding  convex outward.

Pectus excavatum is a deformity of the chest wall with the sternum sunken in or concave in appearance.

Scoliosis is a curve of the spine.  Kyphoscolisos is an upper back arching curve, and lordosis is a lower back arching inward.

It is up to the surgeon to determine which implant would look best with a chest wall deformity, sometimes bigger (or smaller) implants are necessary to achieve the result than with a normal shaped chest.

All the tricks we use to pick implant size should be used; before and after pictures, photos, measurements, and especially implant sizers.  Your surgeon may need to make intraoperative decisions regarding symmetry and final volume, but a reasonable size should be chosen before hand.  The difference between a 400 cc implant and a 240 cc implant is not as great as you might think.  Perhaps the correct size should split the difference between 400 and 240, 320 cc.

 

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 45 reviews

Breast augmentation surgery results

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The outcome of your surgery depends on who performs your surgery. Your situation is different than most patients in that your implants will tend to move to the side; careful and accurate pocket dissection is critical.
It is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 719 reviews

Choosing implants

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Choosing the right implant for you is a lengthy discussion and exam performed by your surgeon. An agreement and rough size range should be discussed with your surgeon.
 

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Bony chest wall variances impact implant selection

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Pectus carinatum otherwise known as "pigeon chest" is a condition in which the breast bone (sternum) articulates with the ribs at a steep angle, which some people liken to the prow (triangular front part) of a sailboat.  Not only is the chest wall sharply pitched, often the pectoralis major muscles are relatively short in distribution and the skin brassiere overly elastic.  The net result is a bony platform, over which implants can displace laterally, (towards the armpits). 

This anatomical variant certainly increases the challenge for the PS to accomodate patient request with what is practical.  I agree with the other consultants that sizing is best done, in person, choosing an implant whose "base diameter" or foot print approximates the width of each hemi-thorax (chest).   Different profile implants correspond to different volumes (cc) and yet may have the same foot print, hence this is a possible explanation why one consultant may recommend a high profile 400cc while the other favors a standard profile 250cc. 

Puhrlz is an online company which sells inserts and a bra, which you could feasibly wear for a few weeks, to develop an idea of what you would really like.  good luck.

Lavinia Chong, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 37 reviews

Try not to commit to strongly so an implant size before surgery

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Hi  there-

I say this to patients and have said it on this site many times... it is a mistake to commit yourself, or ask your surgeon to absolutely commit to an exact implant volume prior to surgery.

For a healthy perspective on this issue, please read this:

Armando Soto, MD, FACS
Orlando Plastic Surgeon
5.0 out of 5 stars 102 reviews

The size, the size

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The appropriate size is selected based on the width of your natural breasts as well as how much breast tissue you have naturally. The width of chest can play a part if the natural breast is unusally small. Here a picture is worth a thousand words.

Dr. ES

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

Breast Implants for Pigeon Breast

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Pigeon breast or pectus excavatum is when, typically, the lower part or sometimes the whole, sternum is bowed outward.  What is interesting with this deformity is what happens to the corresponding ribs.  Much of the time the ribs are actually concave or bowed in necessitating larger implants as they need to fill the additional depression.

However, I have seen many different variations on this deformity including very prominent convex or bowed out rib or ribs, convexity on one side with concavity on the other, flat ribs etc..  An appreciation of the ribs is essential to choosing the correct implant.  With that said it is often necessary to determine the best implant after the ribs have been surgically examined.  You need to have a surgeon who understands this deformity and the many different variations and therefore implants that could be needed.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
5.0 out of 5 stars 17 reviews

Bigger is NOT Always Better when it comes to Breast Implants

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Professional Breast Augmentation surgeons are similar to professional Golfers or professional poker players. Although we would love to be able to change the rules on occasion, the facts are that we must play the golf ball where it lands, the poker hand dealt us and must operate on the (pigeon) chest and breasts the patient posses.

A pigeon chest ALREADY means that the plane of the chest is not flat but skewed and that the taller and wider the structure (IE implants) placed on it will lean or fall to the sides.

In your case, if you absolutely had to augment your breast volumes, I would advise you go with the smallest implants you could live with. Although the use of sizers in the OR is a good idea, I would definitely advise you NOT to go with 400 cc implants. They will do battle with your forward moving arm each time and you will look very top heavy.

Get at least one other opinion from a real Plastic surgeon (www.PlasticSurgery.org) before having this operation.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.