Chest Wall Reconstruction


Pectus Excavatum, also known as cobbler’s chest, sunken chest, funnel chest or simply a dent in the chest, is the most common congenital chest wall deformity, in which several ribs and the sternum grow abnormally. This produces a caved-in or sunken appearance of the anterior chest wall. Typically present at birth, this condition continues during the time of rapid bone growth and worsens until early teenage years. The severity of the defect and asymmetry of the chest widely vary. Pectus excavatum is often considered to be cosmetic, however it can impair cardiac and respiratory function, causing pain in the chest and back. People with the abnormality may experience negative psychosocial effects, and avoid activities that expose the chest.

Chest wall reconstruction presents many challenges to repair the deformity. Fortunately, many procedures have been developed in order to correct the appearance of the chest using chest wall reconstruction. Dr. Donald Nuss, based at Children’s Hospital of the King’s Daughters in Norfolk, Virginia, developed a technique to correct pectus excavatum in children. The Nuss procedure involves slipping in one or more concave steel bars into the chest, underneath the sternum through two small skin incisions along the axillary lines. The bar is flipped to a convex position so as to push outward on the sternum, correcting the deformity. The bar usually stays in the body for about two years, although many surgeons are now moving toward leaving them in for up to five years. When the bones have solidified into place, the bar is removed through outpatient surgery.

For male patients, I found that custom made solid pectoral implants made specifically for the area of depression is an impressive option for a better cosmetic result. Pectoralis implants can be used to augment the male chest wall. Implants can be used to provide additional projection of the chest wall enhancing the appearance and often times self image of the patient. In order to meet the needs of the specific patient, I meet with the patient to make the moulage for the custom silicone implant.

This preparation can take up to 1-2 hours to make and dry. The moulage is then sent to the company so that a solid silicone implant can be made from it to fit the patient. The specifics of the operation vary from patient to patient. During the consultation with the patient, I discuss the amount of augmentation that the patient desires. The preferred shape of the chest wall is also discussed with the patient. Pectoralis implants have been very successful in allowing the patients to achieve increased fullness in the chest area.

The Surgical Procedure:
This operation may serve to correct a congenital deformity or tear of the pectoralis muscle. The procedure takes 2 hours and is performed under general anesthesia. Generally, the procedure is done through an incision in the axillary (armpit) area. The silicone implants are placed underneath the pectoralis muscle.

What to expect after surgery:
After surgery, I require my patients to get lots of rest. Expect that the chest will feel somewhat sore for the first few days, but this should abate very quickly and by the end of the first week you should be comfortable. Patients are often back to work 1-2 weeks after the procedure.

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San Diego Plastic Surgeon