Clinical scenario
The patient is a 17-year-old girl, high school student, athletic, with no respiratory or cardiac issue, consulting for the treatment of a visible breast asymmetry, bothering her on an aesthetically point of view. The clinical examination reveals an asymmetrical pectus excavatum, type 3, with a severe chest depression on the right, inducing a breast asymmetry. The asymmetry causes significant psychological discomfort, actually compensated in the bra.
I offer her a surgery with the placement of a silicone rubber 3D custom-made implant that will permanently correct her thoracic deformity and her breast asymmetry, without using classic techniques as lipofilling or standard silicone gel breast implants.
Surgery
A scanner of the thorax is performed allowing the engineer team to create a "digital body" (Figure 1) of the patient and see the genuine image of the deformity, leading to the creation of a « digital » volume of the future implant: the breast asymmetry will be corrected by a slight over-correction of the implant (Figure 2).
The surgery is performed under general anesthesia. The custom-made implant is placed behind the pectoral muscles, through a vertical inter-mammary incision of 7cm. Hospitalization lasts 24 hours, 3 postoperative punctures are necessary. The follow-up is not very painful and 7 days after the surgery, the patient is able to come back to high school and prepare for her A-level. Sport is stopped for three months.
Outcomes
The preoperative (Figure 2) and postoperative photos at one year (Figure 3) show a perfect correction of the Pectus with a discreet scar.
One year after the surgery, the improvement is obvious. The patient is not bothered by the slight breast asymmetry remaining due to the difference of glandular volume, but there is no impact in her daily life. She is not bothered either about practicing sports. The patient, satisfied, does not want additional lipofilling.
Author and bibliography
Author
Dr. Bettex is specialized in plastic, reconstructive and aesthetic surgery practicing procedures of breast, face, skin... He has been operating the pectus excavatum for a year with custom-made 3D implants with great success. Trained in the technique of custom-made thoracic implants at the Marseille University Hospital, he now works in a private practice in Aubagne.
