Breast Implant Placement with Pectus Excavatum?

I have tended to place the implants under the muscle because the breast and skin can be very thin over the pectus and can make the implants more visible with a higher chance of rippling. However, I also inform my patients that the implants tend to slide towards the middle of the chest creating very pronounced cleavage with nipples that tend to face inward (cross-eyed appearance).
I have a video below which demonstrates 3 varying cases of pectus excavatum breast augmentation with implants. Please forward to 1min 30 secs.

Of course, breast implantation placed subpectorally can very effectively mask many of the chest wall deformities with pectus excavatum unless it is severe.

In my experience, breast implants tend to help “camouflage” the concavity,  making the cleavage area look deeper. Often times postoperatively is hard to know that the patient  initially presented with pectus excavatum.  I usually recommend under the muscle for longer term results as well as reduction in potential for rippling and palpability of the breast implants.  Each patient is different so it will be best to have an examination.

 

Often, patients with pectus excavatum have medially sloped chest walls ( sloped towards the cleavage area);  care must be taken during the breast implant pocket dissection to avoid the implants coming together too close in the sternal area.

Also, patients with pectus excavatum may have their nipple/areola complexes relatively medially positioned on their breasts;  without intervention this inward  leaning appearance of the nipple/areola does not improve with breast augmentation surgery.

I would suggest that you meet with well experienced board-certified plastic surgeons;  asked to see lots of examples of his/her work.

Best wishes.