Pectus Carinatum Breast Aug, Hope for revision with cleavage? (photo)

I had a saline breast aug back in 2000 with an ENT doc moonlighting as a plastic surgeon (I know, big mistake) I have pectus carinatum. My breasts have moved under my arms a lot, but I'm afraid to close the pocket since Ive already lost feeling on my left nipple. A cup, thin skin, bony chest…want kids in couple of year maybe I should wait? Ive heard I can cut some muscle midline to help with cleavage. I hate them though…what can be done to help? Anything?

Doctor Answers 17

Pectus Carinatum Breast Aug, Hope for revision with cleavage?

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In the posted photos I do not see a "Pectus Carinatum" or pigeon keel appearance BUT I see a "Pectus Excavatum". Yes you need revision lateral pocket repair and I recommend fat grafting to sternal deformity...  

Pectus Carinatum Breast Aug, Hope for revision with cleavage?

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Thank you for the question and pictures. You have done a nice job, with the pictures, demonstrating your concerns. Internal suture repair of the breast implant capsules ( capsulorrhaphy) will be necessary to prevent breast implant displacement and better center the breasts on the chest wall.  In my practice, this repair is done with a 2 layered permanent suture technique. The use of acellular dermal matrix is an option ( although not usually necessary)  especially if significant implant rippling/palpability is present.

During the procedure, the capsule close to the sternum may need to be opened as well ( reverse capsulotomy). Depending on your goals and measurements, changing breast implants may or may not be necessary. You may find the attached link, dedicated to revisionary breast surgery information, helpful to you. Best wishes.


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I feel fairly strongly that you need internal support to get a stable, long lasting result.  It is not an easy surgery and adds cost but is a better long term outcome. Be careful to not get in the mindset of increasing your implant size to " catch up with loose skin".

Edward S. Gronka, MD
Fayetteville Plastic Surgeon
4.7 out of 5 stars 13 reviews

Implant malposition issue- laterally falling off chest

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If your implants are falling off your chest, then the pocket is most likely too big and needs to be reduced.  There also seem to be other issues as well. Best to be seen in person.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Improving cleavage

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Based on your pictures, you have a high likelihood of having an excellent result. Suturing of your pocket (capsulorrhaphy) and mirror image capsulotomy (cutting of the capsule) along with an implant exchange to a high profile silicone implant would be appropriate. It is possible that you might need a donut or circumareolar mastopexy. That decision would need to be made at the time of consultation. You actually are an excellent candidate.

Paul E. Chasan, MD
Del Mar Plastic Surgeon
4.9 out of 5 stars 46 reviews

Implant Malposition

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I am sorry you are having this problem.  Along with figuring out how to fix it, we should think about how to prevent it from happening again too.  Releasing muscle at the midline will open the pockets up, but that will not have any effect on the implants as they will always find lowest ground, which are the wide open sides of the pockets. Releasing muscle may help with the contraction deformity you're having on the right side, though. 

There are two techniques that will allow repositioning of your implants. One, that everyone mentioned but you specifically are not interested in is capsulorrhaphy, or sewing down the side walls of the pocket, making it effectively smaller by limiting its lateral extent.  Although this is unlikely going to harm sensory nerves emanating from that lateral tissue, I suppose it's possible.

Your only other choice is creating an entirely new, subpectoral pocket by dissecting the old capsule wall off of the underside of the pectoralis muscle and breast tissue inferiorly. Once the desired limits of the pocket have been reached, the two layers of old capsule (anterior and posterior leaflets) are sewn together, obliterating the old pocket; this is done centrally, where there are no sensory nerves to entangle. This neo-subpectoral pocket gives the implant a 'second chance' in a more idealized place while still being in a partial subpectoral position.

In terms of preventing a recurrence, I suggest switching to as low a profile silicone gel implant as possible.  This prevents the 'water hammer' effect of saline, and the lower profile distributes pressures most evenly, both diminishing unpredictable tissue stretch and malposition.  Additional considerations include choosing a textured implant and acellular dermal matrix (ADM) support.  There is no cost to choosing textured implants, but there is a substantial cost (more than the implants) of using an ADM like Strattice or Alloderm.  In my estimation, your situation does not warrant using ADMs unless we are also looking to minimize implant rippling/palpability.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews


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First you need to decide whether you wish the surgery now or after children.  Either way the problem can be repaired and better cleavage restored

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 65 reviews

Breasts under arms

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You need to consider the best option but most difficult is too take your implants out and wait 3-4 months then have new implants placed. This plan has the highest degree of minimizing other "touch up" surgeries and will not be relying on sutures or very expensive ADM products. If you were my sister I would recommended this but of course would have kept you out of the ENT docs hands first. Good Luck.

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 62 reviews

Complex revision

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It looks like 1) you implant pockets have stretched out infero-laterally, and 2) you have dynamic flexion issues on the right.

I would suggest:
1)  an infero-lateral pocket repair, (possibly with ADM, especially if you have ripple issues)
2)  conversion to dual plane placement to reduce muscle motion issues
3)  think about switching to silicone gel - fewer ripples, some feel less potential for tissue stretch
4)  medial capsulotomy to open pocket in central zone
5)  make sure implant diameter is well suited to pocket diameter.

Make sure you go to see someone who is well-versed in complex revisions.

Pectus Carinatum Breast Aug, Hope for revision with cleavage?

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    An exam will be beneficial in your case, but a breast implant revision to close down the lateral aspect of the pocket along with fine alteration of the pocket medially will likely give you a much better appearance with better cleavage.  Make sure that the plastic surgeon is a true expert in revision breast augmentation.

Kenneth Hughes, MD

Los Angeles, CA

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.