Chest Wall Recontsruction

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Pectus Excavatum, also known as cobbler’s chest, sunken chest, funnel chest or simply a dent in the chest, is the most common congenital chest wall deformity, in which several ribs and the sternum grow abnormally. This produces a caved-in or sunken appearance of the anterior chest wall. Typically present at birth, this condition continues during the time of rapid bone growth and worsens until early teenage years. The severity of the defect and asymmetry of the chest widely vary. Pectus excavatum is often considered to be cosmetic, however it can impair cardiac and respiratory function, causing pain in the chest and back. People with the abnormality may experience negative psychosocial effects, and avoid activities that expose the chest.

     
           
           
Fortunately, many procedures have been developed in order to correct the appearance of the chest using chest wall reconstruction. Dr. Donald Nuss, based at Children’s Hospital of the King’s Daughters in Norfolk, Virginia, developed a technique to correct pectus excavatum in children. The Nuss procedure involves slipping in one or more concave steel bars into the chest, underneath the sternum through two small skin incisions along the axillary lines. The bar is flipped to a convex position so as to push outward on the sternum, correcting the deformity. The bar usually stays in the body for about two years, although many surgeons are now moving toward leaving them in for up to five years. When the bones have solidified into place, the bar is removed through outpatient surgery.
           
                         

This 21 year old male from San Marcos, California came in to meet Dr. Pousti because he was very uncomfortable with his chest wall. He had the Nuss Procedure when he was younger but was not happy with the cosmetic result. Using a moulage to create a silicone pectoral implant, Dr. Pousti performed chest wall reconstruction to improve the look of the chest.

Chest wall reconstruction presents many challenges to repair the deformity. Dr. Pousti has considerable experience using both pectoral implants and breast implants in both men and women to improve the appearance of the chest wall for patients with pectoralis excavatum.

For male patients, Dr. Pousti found that custom made solid pectoral implants made specifically for the area of depression is an impressive option for a better cosmetic result. Pectoralis implants can be used to augment the male chest wall. Implants can be used to provide additional projection of the chest wall enhancing the appearance and often times self image of the patient. In order to meet the needs of the specific patient, Dr.Pousti meets with the patient to make the moulage for the custom silicone implant.

 

        

This preparation can take up to 1-2 hours to make and dry. The moulage is then sent to the company so that a solid silicone implant can be made from it to fit the patient. The specifics of the operation vary from patient to patient. During the consultation with the patient, Dr. Pousti discusses the amount of augmentation that the patient desires. The preferred shape of the chest wall is also discussed with the patient. Pectoralis implants have been very successful in allowing the patients to achieve increased fullness in the chest area.


           

This operation may serve to correct a congenital deformity or tear of the pectoralis muscle. The procedure takes 2 hours and is performed under general anesthesia. Generally, the procedure is done through an incision in the axillary (armpit) area. The silicone implants are placed underneath the pectoralis muscle. After surgery, he requires his patients to get lots of rest. Expect the chest will feel somewhat sore for the first few days, but this should abate very quickly and by the end of the first week you should be comfortable. Patients are often back to work 1-2 weeks after the procedure.  

      

This 24 year old male from Texas flew in to meet Dr. Pousti because he was very uncomfortable with his chest wall. He did not like having his shirt off and it was bothering him more and more. He found Dr. Pousti on the internet, met with him, and decided that he was the right surgeon for him. He is 3 months post op surgery and very happy with his results.

       

Breast augmentation to repair pectus excavatum in women takes approximately two hours. During the consultation and after a thorough examination, Dr. Pousti will discuss every detail of your breast augmentation, including the exact size and type of breast implants he will use and their relative advantages. This procedure to correct pectoralis excavatum is performed on an outpatient basis at our surgical center in San Diego under general anesthesia. By positioning the correct size/shape of breast implants on the chest wall, the pectus excavatum is camouflaged nicely giving the patient’s breasts the appearance of "deep cleavage". Pain is usually relatively little, Bed rest, along with plenty of fluids, is necessary after surgery. The chest will be sore but Dr. Pousti will prescribe appropriate pain management and muscle relaxant medications. Taking medications regularly and keeping up with office visits will ensure a great recovery. Usually after a week, patients go back to their normal living. A brassiere and bandeau will be fitted for you during the first week of recovery. These will need to be worn for a month. You will not be able to shower until your sutures are removed. Initially, breast implants will appear to be slightly higher than normal and your breasts will be swollen. Over time, the breast implants will descend to a more natural position.

               

This 27 year old patient from San Diego, CA was unhappy with the appearance of her chest. She was told she had pectus excavatum. She found board certified Plastic Surgeon, Dr. Tom Pousti who had performed this procedure multiple times with wonderful results. She is very happy with her new and improved look.

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