Chest Wall Reconstruction
»Post-Op Care Instructions
Chest Wall Reconstruction:
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.
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The Surgical Procedure:
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.
What to expect after surgery:
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 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.
Here is a picture of the solid silicone implant that will be placed on the patient’s chest wall.
This is in the operating room, Dr. Pousti shows the significant depression of this patient’s right chest wall.
Pictures were taken in the operating room immediately after the procedure.
After the custom implant has been placed.
“Dr. Pousti is the best of the best I wouldn’t have changed any of my previous decisions. Before and after pic’s say a lot!! Thanks Dr. Pousti.”
“I have a congenital abnormality of the chest wall called pectus excavatum. It is caused by abnormal growth/positioning of the ribs and sternum, and results in an indentation in the middle of the chest. The degree of indentation in my case (Haller index of 4.3) was considered “severe” by the medical community. To correct my condition, I first considered undergoing a surgery called the “Nuss Procedure”. That procedure is a major surgery – it is quite intrusive and involves all the risks of major surgery along with a long and painful recovery period. It is also normally reserved for adolescent patients – which I am not. After becoming aware of all the risks and potential problems associated with that procedure, I began to look for other less invasive options.*
*My research turned up a plastic surgeon named Dr. Tom Pousti who specialized in treating chest wall abnormalities like mine. During my consult with Dr Pousti, he and his entire staff were very courteous and professional. He explained how they could have a custom silicone implant made to exactly fit the shape and size of my indentation. He was very optimistic about his ability to treat my specific condition, but was also realistic about exactly what I could expect. This option seemed very attractive to me since it was much less intrusive/risky than the alternative (Nuss) surgery. Also, I was a good candidate for this type of “cosmetic” procedure since, although my condition was considered “severe”, it was not so severe as to be impacting my heart or lung function. *
*Dr. Pousti performed my implant surgery in April 2015. The surgery and recovery all went extremely well and there were no complications of any kind. My post-surgery progress was monitored closely by Dr. Pousti and his staff. His assistant Daisy was very engaged throughout and I remember receiving many calls from her inquiring about my status – sometimes even
after normal business hours and on weekends! The implant fit very well – essentially I didn’t even know it was there. Aesthetically, the result was very good, but the implant was visibly noticeable in certain conditions and I was interested to know if it could be further improved. I discussed my feelings with Dr. Pousti in several of our post-surgery follow-up meetings and he offered that it would be possible to further tailor the front face of the implant and blend it better with the contours of the chest wall. After thinking about it for some time, I decided to go ahead with the surgery.*
*Dr. Pousti performed this 2nd surgery to refine the shape of the implant in Jan 2016. (He did not charge any additional fee for his services for this surgery.) Again, he and his team did an excellent job with the surgery and there were no complications of any kind. All of our objectives for the surgery were accomplished and now I can say I’m 100% happy and the
result looks and feels great! *
*Thank you Dr. Pousti for being such a skilled professional and for standing behind your work!”