Interested in Breast Augmentation. Had Nuss Procedure. What are my options to achieve symmetry and cleavage? (photos)

Question

Pectus Excavatum - had the Nuss Procedure - still have titanium bar in my chest. (Still have a slight indentation and unevenness) Interested in Breast Augmentation to create a more balanced and fuller chest. Interested in cohesive gel placed under the muscle. Interested in 500-600cc

Lane Smith, MD · Answer

Thank you for your question. Based on your submitted photos you appear to be an excellent candidate for a breast augmentation procedure to produce beautiful overall results. Schedule a consultation with a board certified plastic surgeon to discuss your surgical options, address your goals and any concnerns you may have, then work together with your surgeon to create the plan that best helps you achieve your overall desired look.With kind regards,

Lane F. Smith, M.D.,
F.A.A.C.S., F.A.O.H.N.S., F.A.B.F.P.R.S.

Las Vegas Plastic
Surgeon

Lane F. Smith, M.D.,
F.A.A.C.S., F.A.O.H.N.S., F.A.B.F.P.R.S.

Las Vegas Plastic
Surgeon

Michelle Spring, MD, FACS · Answer

Hi there, thanks for the
question.A breast augmentation or fat
transfer to the breasts couldhelp with
balance and fullness in the breasts.It
will also help camouflage any concavities remaining.The asymmetry in your breasts can be
improved, but you will likely still be asymmetric.  Best of luck!Sincerely,Dr. Michelle Spring

Aaron Stone, MD · Answer

Your posted photos show rib cage asymmetry, asymmetric breasts, a lower left than right inframammary fold, right nipple further from the midline and higher than the left nipple and a concave inner upper left chest. Clearly implants alone even if of different sizes are not a good idea and exact symmetry is not in the realm of possibility. In discussing this with your surgeon you need to go over all of the options that would move you towards a more symmetric appearance possibly raising the left fold and adjusting the right nipple position. I do not think any implant will suffice to fill that left chest concavity so you will likely need to consider fat grafting to that area. Since different sized implants will be required you should also consider saline vs. silicone as your surgeon would be able to adjust saline implant size on the operating table for the best match.Your case is sufficiently complex that you should not just see one surgeon and do what they say. A reasonable result is achievable with more than one approach. You just need to make sure that the approach makes sense and covers all bases, you have confidence in your surgeon and you are open to a staged procedure.I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

Michael F. Bohley, MD · Answer

Thanks for you question and photos. It appears that you had a very good result following your thoracic procedure. As you know, the titanium plate used for the correction is internal, and therefore should notpreclude you from having implants placed between the chest wall and pectoral muscles. Breast implant placement can serve to 'camouflage' remaining thoracic asymmetries.  Your photos do show some minor nipple-areolar asymmetry which will not be corrected by implants alone. With regard to the best implant style and size, I would always recommend that you follow the expert advice of your local plastic surgeon. Best of luck to you.

Armin Moshyedi, MD · Answer

Your right breast is smaller with a higher crease which can be improved with breast augmentation. The right nipple is also higher than than the left and would remain that way after breast augmentation unless you have a lift on the left (we can't lower nipples easily, only raise them). Breast asymmetry is very common, and if the nipple positions don't bother you I suggest leaving them alone. You and your surgeon can end up chasing your tail doing too much to get them symmetrical and never getting it perfect.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.  Based on your photographs, I think that you may be an excellent candidate for breast augmentation surgery. The use of different sizes/profile breast implants are often very helpful when it comes to improving breast symmetry. In my experience, 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. 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.  Based on your photographs, this is not seem to be relevant in your case.Generally speaking, the best online advice I can give to ladies 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 are looking for. Ask to see lots of examples of his/her work.
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. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know 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. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
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 the use of temporary intraoperative sizers.I would suggest that you meet with well experienced board-certified plastic surgeons; asked to see lots of examples of his/her work.  You may find the attached link, dedicated to breast surgery for patients with pectus excavatum, helpful to you as you learn more.
Best wishes. It will go as well as

Alex Kim, MD · Answer

Based on the photos, you have minor asymmetry of the breast shape, volume and position.  Breast augmentation is a reasonable procedure to achieve symmetry.  Even with implants, the position of the nipples would be asymmetric (you will need a lift to make the nipple even).  But the position of the beast and volume can be significantly improved by the augmentation.  500 cc would be a little large, but that is one thing you need to discuss with your surgeon.  In addition, you may consider fat injection to the areas of indentation to give more fullness and roundness to the breast afterward.  Best,

Marc J. Salzman, MD, FACS (retired) · Answer

From your photos, when there is that much asymmetry of your chest wall breast implants may not totally correct or hide the situation. The wider the breast implant that will fit the more you will hide this discrepancy. However, the base width of your breast seems quite narrow. You would be at a risk with too wide of an implant for a double bubble. Try to find a plastic surgeon with Vectra 3-D imaging. With that technology, multiple scenarios of different sizes, shapes, and projection ratios can be placed on a three dimensional picture view such that the best matched pair of implants can be chosen. Good luck on your surgery.

Interested in Breast Augmentation. Had Nuss Procedure. What are my options to achieve symmetry and cleavage? (photos)

Answers (8)

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