Correction of Chest Wall Deformity Patients

This 27 year old patient from Austell, Georgia was unhappy the appearance of his chest for several years. The patient was interested in getting corrective cosmetic surgery to fix the appearance of his chest wall.  He was told that he had pectus excavatum and there wasn’t much he can do.  While researching online to find a surgeon he came across Board Certified Plastic and Reconstructive Surgeon Dr. Pousti, who was also experience in chest wall reconstruction.

The patient looked at several before and after pictures and was happy with what he saw. The patient decided it would be worth it to fly into San Diego from Georgia. Upon examination it was determined the  patient that  had lower sternum pectus excavatum. (Pectus excavatum is the most common type of congenital chest wall abnormality.) The patient was extremely happy with his consultation and scheduled his surgery with Dr. Pousti.

During the patients visit to Southern California, a special moulage is taken of the depressed area of the patient’s chest.

The manufactures use this moulage to make the patient’s custom silicone implant.

Markings are made prior to surgery and used to explain what the doctor will be doing during the procedure.

The red markings below indicate the highest amount of depression in the patient’s chest wall. The blue markings indicate where Dr. Pousti will be inserting the pectus implant.

Pectus Implant

The patient is 2 days out of surgery and happy with his initial results.

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Posted in Chest Wall Reconstruction, Correction of Chest Wall Deformity, Pectus Excavatum

This 52-year-old male patient from Mannford, Oklahoma was unhappy with the appearance of his chest wall due to pectus excavatum deformity.

During the patients consultation a moulage was made so that it could be sent to construct a custom implant for this depressed area.

Measurements were made prior to surgery to show where the deepest parts of chest wall depression were located. Once measurements are taken, markings are made to show where the implant should be positioned.

An incision is made along the chest wall so that the custom implant can be placed under the pectoralis muscle. The location of the incision is always placed in an area that can easily be hidden.

As you can see immediately after surgery the custom implant filled the depression in the chest wall and created symmetry.

Before

Immediately After

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Posted in Correction of Chest Wall Deformity, Pectus Excavatum

This 21-year old patient from San Marcos, California (North San Diego County) came in to meet Dr. Pousti because he was VERY UNCOMFORTABLE with the appearance of his chest wall.

He had the Nuss Procedure when he was younger but was unhappy with the cosmetic result of his surgery. The Nuss Procedure is performed for medical necessity. Children with moderate to severe defects often experience shortness of breath, exercise intolerance and chest pain. These are the results of compression and displacement of the heart and secondary lung compression.

He and his mom found Dr. Pousti on the Internet when they searched “custom pectoralis implant”. They had seen that Dr. Pousti is a double board certified Plastic and Reconstructive Surgeon with a lot of experience with pec implants, pectus excavatum and chest wall reconstruction. Pectus excavatum, also known as funnel chest, the sternum (breastbone) is depressed relative to the rest of the chest wall. After meeting Dr. Pousti at his San Diego office, and discussing the procedure in detail, the patient wanted to proceed with surgery.

Dr. Pousti marked the depressed areas

A moulage was made as a guide for the custom silicone implant.

Markings were made in detail for the planned procedure.

The severity of the patient’s chest depression is shown.

The incision from his previous “Nuss procedure” was used, in order to avoid creating additional scars.

Custom silicone implant

The implant is prepared for placement.

Immediately after surgery.

The depression of the right chest is filled and symmetric.

The patient is now 2-weeks post-op surgery.

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Posted in Chest Wall Reconstruction, Correction of Chest Wall Deformity, Custom Pectoralis Implant, Pectus Excavatum, Procedures for Men

This is a 29 year old male from Tempe, Arizona had a history of pectus excavatum. He underwent reconstruction surgery using the Ravitch Procedure at the age of three and again at the age of twenty-two. He was still unhappy with his results and decided to do research online to find a qualified plastic surgeon.

During his appointments with Dr. Pousti the patient expressed that he was unhappy with the appearance of his anterior chest wall (depressed). It was also apparent that bilateral gynecomastia surgery was needed as well.

Measurements of the patient’s chest are taken and markings of the depressed areas are made. After markings a moulage of the patient’s chest is done.

The moulage is then sent out to be used as a template for construction of a solid silicone implant.

Once the custom Silicone implant is completed the patient is ready for the procedure. These custom implants are much different from the ones used during breast augmentation surgery and are designed to give a nice natural look/feel. The patient was then taken to the operating room and the custom silicone implants were placed through previous incisions in order to fill the chest wall concavity-depression.

Partial subcutaneous mastectomy was performed as well to decrease the size of each breast.

Subcutaneous tissue removed from the breasts

Patient’s Left breast after the Gynecomastia procedure

The combination of filling in the central chest wall concavity as well as decreasing the size of the breasts bilaterally served to smoothen out the appearance of the anterior chest wall nicely.

The patient is placed in an upright position several times throughout the surgery to ensure that symmetry is achieved. Any adjustments are done prior to final suturing if needed.

Four drains were used for the procedure and a compressive dressing was applied. Drains are typically used during reconstruction surgery to prevent fluid buildup and promote infection-free healing.

Before Chest Wall Implant and Gynecomastia

After Chest Wall Implant and Gynecomastia

Before Chest Wall Implant and Gynecomastia

After Chest Wall Concavity and Gynecomastia

The patient is now 1 month post operative.

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Posted in Chest Wall Reconstruction, Correction of Chest Wall Deformity, Gynecomastia

This 24-year old patient from Texas is status post Pectus Excavatum surgery in 1992 (performed by another surgeon). The patient was unhappy with the appearance of his chest from the results of his previous surgery.

The patient expressed, he was uncomfortable with and without a shirt on. The patient and his mom researched for an experienced Board Certified Plastic and Reconstructive Surgeon to perform his surgery and from reading many excellent reviews of Dr. Pousti’s work, the patient found Dr. Pousti on the Internet. The patient and his mother flew into San Diego to meet with Dr. Pousti.

During the consultation visit to San Diego, a “Moulage” was made; the moulage is a mold that is shaped accordingly to the patient and dried. It is then sent to the manufacturer to be made into a solid custom silicone implant. And surgery was scheduled.

Markings were made the morning of surgery.

Markings in red, show the depth of the depression in the lower chest cavity area.

Incisions made, the chest is prepared for the silicone implant.

Custom silicone implant

Immediately after surgery.

The patient is now 18-months post-op surgery and is very happy with his results. The patient sends pictures via e-mail.

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Posted in Chest Wall Reconstruction, Correction of Chest Wall Deformity, Procedures for Men

This young man was not happy with his chest wall. He did not feel comfortable taking off his shirt at the beach or the pool. He wanted to have chest wall reconstruction. He started doing research and found San Diego Plastic Surgeon, Dr. Tom Pousti. After seeing many examples of chest wall reconstruction with custom made solid silicone implants, this patient decided to proceed with surgery.

As you can see in these pictures, the center of the patient’s chest has a significant indentation visible. This is what the patient was uncomfortable with.

Dr. Pousti took his time marking the area that bothered the patient while discussing with the patient how the procedure would be performed.

The first step would be to prepare the “moulage” (which is a mold of the area that needs to be treated) which would then be sent to the company that Dr. Pousti uses to have a custom made solid silicone implant made for this patient.

The custom implant is made in 6-8 weeks and the patient is ready to proceed to the operating room.

Here is the solid silicone custom implant

Dr. Pousti in the operating room.

You can see the indentation

After the implant is placed.

As you can see in this picture taken immediately after the procedure is completed in the operating room, the center portion of the patient’s chest (which used to have a severe indentation) is now completely level.

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Posted in Chest Wall Reconstruction, Correction of Chest Wall Deformity, Procedures for Men