Unilateral pectus carinatum & BA (Photo)

Question

I havent been officially Dx but i remember my parents referring to a bony prominence L Mid sternum, as pigeon chest. I do also have mild scoliosis. I am looking for BL/BA. The PS yesterday said the implant on that side wouldnt sit right. Do I accept this and just get a loft and fat transfer or are there PS out there that can compensate for this deformity? I have rrad women getting BA to hide it one hasnt been noticeable since before puberty

Brian Bassiri-Tehrani, MD · Answer

This is a good question. Breast implants in patient's with pectus carinatum and bony prominences on their chest can slide off the chest wall, sometimes leading to implant malposition. An internal bra (mesh) can be used to secure the implant in place to prevent the implant from moving to unintended places. Instead of implants, an alternative is to have a fat transfer to your breasts. Fat grafting can be done in a way that can compensate for the pectus carinatum. In conjunction with a breast lift, either procedure (implants or fat) is feasible, it just depends on your preference.

Joshua T Halka, MD · Answer

Hello,
If your chest wall is sloped differently from side to side this will definitely cause the implants to sit slightly differently, just as natural breast tissue would if the chest wall is different from side to side. 
I wouldn't let this stop you from undergoing a breast augmentation and lift, any large asymmetries could be adjusted with skin revisions, implant pocket revisions, or fat grafting.
Hope this helps!
-Dr. Halka

Chul Hwan Seul, MD, PhD · Answer

Looking at the shape of the breast, a breast lift seems necessary, and breast augmentation using an implant seems necessary to correct the sunken upper pole of the breast. However, even with this surgery, it is difficult to resolve the pectus carinatum and wide intermammary span, so it would be best to do fat grafting together.

Gary M. Horndeski, MD · Answer

The technique I recommend is a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gianfranco Frojo, MD · Answer

It is difficult to determine from these photos exactly what is going on with respect to the sternum/rib cage anatomy. I would recommend finding a board-eligible or -board-certified plastic surgeon with experience in complex breast surgery. A physical exam will be necessary to truly determine what is happening with that area that you have circled. Best of luck

Gerald Minniti, MD, FACS · Answer

Two dimensional photos make an accurate assessment of three dimensional structures difficult, however, pectus carinatum (PC) does not have the appearance of your central chest. You appear to have a flaring of your lower sternum and/or a depression of your mid-sternum. PC is a vertically oriented projection of the sternum with a steep drop off of the ribs as they make their way around to the back. This typically makes it harder to keep implants from separating away from your sternum. You appear to have a mild variant of pectus excavatum, which in more severe forms tends to make implants come too close together. Regardless, you would get a nice result with an implant based augmentation and breast lift. I would keep searching for a surgeon who can be confident that your results will be pleasing.

Daniel Barrett, MD · Answer

Dear sarajannae,
it is hard to tell for sure without an examination. Based on your photos, it looks like you would benefit from breast lift. Implants would improve the appearance of your breasts. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Zoran Potparic, MD · Answer

Prominent chest deformity may interfere with your breast lift to a certain degree. Only when breast lift surgery is completed your surgeon should evaluate what can be done to further correct (camouflage) chest deformity. Hope this helps. Good luck

Ram Kalus, MD, FACS · Answer

An examination in person would be required to properly evaluate you and stage optimal treatment plan but based on your photo alone I would respectfully disagree with your first opinion. In my own practice I almost always use exclusively Moderate Profile (wider and less projecting) implants in the setting of augmentation mastopexy (breast lift with implants) since you need more volume and width than projection, the latter of which should be adequate because of your existing breast volume. 
With regard to how the implant would sit on your chest under your breast, I generally recommend placing the implant ABOVE the muscle. This allows for a more natural anatomic placement that would most accurately mimic the natural breast. 
Continue to do your research and consider another opinion by an experienced board certified plastic surgeon whose aesthetics align with your own based on his or her Before and After gallery. Best of luck to you.

Michael S. Kluska, DO · Answer

I am very familiar with your condition and treat many patients with anterior chest wall deformities. That said, I think that you could achieve a very nice result with a breast lift plus or minus breast implants. Stage in your procedure by having a breast lift first and coming back and placing implants in in the submuscular pocket at a later stage is a very reasonable option to see how you heal from the original surgery.

Unilateral pectus carinatum & BA (Photo)

Answers (12)

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