Thank you for the question. In my experience, well-placed and appropriately selected breast implants tend to help “camouflage” the concavity associated with pectus excavatum, 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.
Patients with pectus excavatum usually 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.
Generally speaking, the best online advice I can give to ladies with pectus excavatum who are considering breast augmentation surgery (regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you're looking for. ***Ask to see lots of examples of his/her work, helping patients with pectus excavatum with breast surgery specifically.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. him 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 or D cup” etc means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate.
The use of computer imaging may also be very helpful during this communication process.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery after careful measurements are made (dimensional planning).
I hope this, and the attached link (dedicated to pectus excavatum correction) helps. You will also find a separate page, on the same website, dedicated to breast asymmetry concerns. Best wishes.