Chest Wall Deformities (Pectus)

Dallas Plastic Surgeon Dr. David Azouz discusses Correction of Chest Wall Deformity: Pectus Excavatum and Carinatum

Pectus deformities are the most common malformations of the bony chest wall. Common abnormalities of the soft tissue of the chest include gynecomastia, lipodystrophy (stubborn fat) and micromastia (small breasts), chest/breast asymmetry, nipple/areolar asymmetry, sagging breasts and can be associated with a pectus deformity. These conditions can persist after a thoracic wall reconstruction and many men and women seek plastic surgery to improve the look of their chest or breasts.

What is Pectus Excavatum?

Pectus excavatum is a concave deformity of the chest wall where the sternum and or ribs appear to be sunken and is sometimes referred to as a “funnel chest”, or “sunken chest”. Pectus excavatum usually presents in young infants and babies. Many patients have surgery to correct the bony abnormalities as children.

What is Pectus Carinatum?

Pectus carinatum is a chest wall deformity that causes the sternum (breast bone) to protrude outward instead of being flat along the chest. Pectus carinatum is also called “pigeon chest” or “keel chest”. Pectus carinatum usually presents as an overdeveloped sternum and can vary in its severity and can be associated with Poland syndrome.

What causes a chest wall deformity?

Chest wall deformities are often genetic and can some times be associated with scoliosis, Poland syndrome, or Marfans syndrome. The majority of patients will have chest wall abnormalities present at birth or in early infancy. Chest wall deformities are thought to occur as a result of uncoordinated growth between the ribs and chest wall. Trauma can also lead to chest deformity or asymmetry.

Scarring after chest wall surgery

Although the majority of patients with pectus deformities undergo repair during childhood, many have persistent scarring and contour abnormalities that can be bothersome later in life. These scars can be hypertophic and painful. Patients who have undergone heart or lung surgery can also have similar scarring. Although the deformities, asymmetries or contour irregularities may not be functionally symptomatic many patients to correct the look of their chest. Cosmetic Pectus surgery for these conditions can be affordable and the cost is often not prohibitive.

Dr. Azouz is often able to perform scar revision concurrently with a liposuction procedure, breast augmentation or breast lift (mastopexy) in women.

Men often choose to have liposuction and removal of gynecomastia with or without the placement of pectoral implants (pec implants).

What operations are possible to improve the appearance of the chest after pectus excavatum or pectus carinatum surgery?

The nuss and Ravitch procedures are effective surgeries in improving the shape and contour of the chest wall to avoid compression on the heart and lungs. Unfortunately, many patients are left with contour irregularities, scarring and persistent aesthetic deformities of the breast and chest. Men often will have concurrent gynecomastia or significant asymmetry. Women will often have hypoplastic (small) breasts or breast abnormalities. Dr. Azouz is able to utilize multiple to techniques to improve the contour of the chest in patients that have had previous chest wall surgery.

For Men:

Pec implants
Liposuction
Removal of Gynecomastia
Nipple/Areolar reduction or augmentation
Fat Grafting
Scar Revision

For Women:

Breast Augmentation with Silicone or Saline Implants
Mastopexy (breast lift)
Nipple/Areolar reduction or augmentation
Liposuction
Fat Grafting
Scar Revision

Why do women choose breast augmentation after sternal/rib surgery?

Women can often have concomitant breast deformities including breast hypoplasia (small breasts) or breast asymmetry. Many women find that breast augmentation after bar placement or removal can improve the look and symmetry of the chest and can conceal or camouflage contour irregularities of the chest.

What is the typical recovery have correction of chest wall deformity?

Dr. Azouz routinely performs correction of chest wall deformities as an outpatient meaning the patient will go home from surgery the same day. The experience is usually associated with much less discomfort than the original boney surgery the patients have experienced with their prior sternal operations. Patients wear compression garments for six weeks after surgery and Dr. Azouz does not routinely place drains. Patients usually avoid light exercise for 10-14 days after surgery. Patients usually return to heavy exercise including crossfit, rock climbing and non-contact sports 6 weeks after surgery.

What are the long-term results after plastic surgery for chest wall deformity?

A number of studies have demonstrated high satisfaction after plastic surgery in patients with a history of chest wall deformity. Patients often feel more comfortable in swimwear and with tight fitting clothing.

How much does correction of chest wall deformity (pectus) cost?

Correction of chest wall deformity/ Pectus surgery costs can widely vary, Dr. Azouz will determine the cost of surgery through history historical and physical examination evaluation. Insurance does not routinely cover the cost of cosmetic improvement of the chest as most insurance companies deem liposuction, breast augmentation (breast implants) and mastopexy to be cosmetic operations.

Schedule Your Consultation

Many patients choose to improve the look of their chest with pec implants, breast implants, liposuction and scar revision can be fantastic options. Contact Azouz Plastic and Cosmetic Surgery to consultation with Dr. Azouz today by using our contact form or by calling 972-702-8888.

WHAT PATIENTS ARE SAYING

“A huuuuuuge thanks to Dr. Azouz and the wonderful job he did on my laser resurfacing. I felt like a million bucks on my wedding day and I couldn't have achieved that level of confidence without him! So grateful!” - Katie

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