Pectus excavatum. Ready to replace my implants. I want to know what my options are. Any suggestions? (photos)

I have pectus excavatum mainly on my right side. I got implants in 2005 to even my chest. The surgeon closed his practice and left town. I don't have records, but I know they're silicone and two different sizes. My implsnts are way too large and my scars are bad. I want the smallest, most natural breast possible. Who can help and how. I do not have before pics, but these photos are what my chest looks like now.

Doctor Answers 4

Pectus excavatum. Ready to replace my implants. I want to know what my options are.

Thank you for the question and pictures.  Based on your concerns and photographs, I think that you may be an excellent candidate for revisionary 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,  appropriately selected 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. 



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.



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. 

Pectus

You appear to be a good candidate for an implant exchange with some pocket modification to a smaller implant. The scars can be easily revised at that time. 

Pectus excavatum. Ready to replace my implants.

Your photos show a rather round and projecting implant which in pectus excavatum can tend to accentuate the gap rather than conceal it. The scar can be revised, and we would suggest a submuscular lower profile silicone gel implant and perhaps a repair and adjustment of the current pocket. Small can be very good and discuss all carefully with a board certified plastic surgeon.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.1 out of 5 stars 39 reviews

Breast Augmentation

Thank you for your question. You would be a good candidate for a breast Reaugmentation using smaller implants and revising your scar. The scars on my patients tend to be hairline. I sew the wound from the inside and apply skin glue. No sutures need to be removed. During your consultation I like to find out your goals (I.e. What cup size you would like to be). It's important to measure the width of your breast to determine which implant you need. There are four different profiles of round silicone implants. They are moderate, moderate classic, high and ultra high profiles. Because you have asymmetric breast you may need a different size profile implants. (I.e. A thinner profile implant on the bigger breast and a thicker profile implant on the smaller breast). I use the bloodless breast technique which I invented. Bleeding is minimal, typically there is no bruising after surgery, and recovery is a lot quicker versus traditional technique. I hope you find this information helpful and for more information please watch the enclosed video. 

Joshua Halpern, MD, PA
Tampa Plastic Surgeon
4.8 out of 5 stars 52 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.