Breast Implant Placement with Pectus Excavatum?

I am considering breast augmentation and I have pectus excavatum. Is it better to place implants over the muscle or under? I am considering 300cc or less.

Doctor Answers 14

Breast augmentation for pectus excavatum

It's difficult to determine the best position of the implants without actually seeing a photo of your chest. If the pectus is severe you may want to get this fixed before embarking on an augmentation. If not, over or under the muscle should be okay. Talk with your plastic surgeon about the pros and cons of over or under the muscle, and check out some before and after photos to determine the look and size that you want. Good luck!

Baltimore Plastic Surgeon
5.0 out of 5 stars 202 reviews

Breast augmentation and pectus excavatum

Patients with pectus excavatum do very well with breast augmentation. You can have the implant placed either under or above the muscle based on your own tissue characteristics and preferences. Having the implants placed under the muscle has many advantages and will give you a good result. The only caveat is having too large of an implant placed and/or violating the space separating the breasts which can lead to symmastia or "one breast". Make sure you discuss all your concerns with your surgeon.

Bahram Ghaderi, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 21 reviews

Breast implants with pectus excavatum

It has been my experience that performing a

breast augmentation

in a woman with pectus excavatum can be performed with under the muscle coverage, yielding a good result. Each patient musct be evaluatied independently and properly consented. There is a little higher risk of symmastia, and classically, the breasts are closer together after surgery. It is best to show a patient pictures of a similar patient so that they can know what to expect. It is also very important to choose the proper sized implant and to not go too large. I recommend you discuss your concerns with the board-certified

plastic surgeon

you choose. I wish you well.

Dr Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

Breast augmentation in pectus excavatum

Hello 3boysmom

My experience with pectus excavatum is very similar to what Dr. Rand describes and I completely agree with his assessment. In our Santa Rosa practice we do submuscular breast augmentation for patients with pectus excavatum and we are careful not to bring those implants to close together as they do have a tendency to fall into the midline. Make sure your surgeon is experienced in patients with pectus and ask to see before and after photos of appropriate patients. Best of luck.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Breast augmentation with pectus excavatum

Because the patient with pectus excavatum has a deeper midline, they will generate much more cleavage faster than one with a flat chest wall. Also, the implants will sit on a bony platform that will encourage them to tumble to the center risking a "uni-breast" deformity. Consequently, the experienced surgeon will use a slightly smaller implant and will go under the muscle and make sure to leave enough tissue intact along the midline to prevent the implants from coming too close. This is more difficult than regular augmentations.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast Implant Placement with Pectus Excavatum

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

Rod J. Rohrich, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 64 reviews

Breast Augmentation and Pectus Excavatum

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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

Breast augmentation with pectus excavatum

Pectus excavatum, like asymmetry, makes it even more necessary to be precise in implant size selection and placement.

The size of the implant is best determined by the width of the breast and the forward profile chosen, not by cc's of volume first. The more forward the profile of the implant, the more the cleavage concavity will be accentuated.

The implant must be sub-pectoral from years of experience both short and long term. Sub-glandular placement will almost certainly result in an unnatural medial edge to the breast eventually. The pocket dissection for the implant and its width can also not violate the medial border (visible inner border along the cleavage) or deformities are highly likely.

The pectus excavatum will not change with the implants and it may look more or less noticeable when the breasts look larger and more forward projected. I recommend no more than a medium profile for the implant in this situation.

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Pectus excavatum and breast augmentation or enlargement with implants

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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

Breast Augmentation with Pectus Excavatum


I agree with the other posts that the implants can be placed above or below the muscle. I prefer sub-muscular implants because the muscle coverage prevents rippling from being noticeable especially in thin individuals. The size sounds about right for you and should not be too large.

In my experienc,e the implants improve the appearance of the pectus in that the indented area of the chest wall is less noticeable.

Joel B. Singer, MD
New York Plastic Surgeon
3.4 out of 5 stars 34 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.