Pectus excavatum is an indentation of the sternum or breast bone. It can vary from very mild to severe indentations. They can be symmetrical in appearance (in the centre of the breast bone/chest) but frequently are asymmetrical where the indentation is more on one side than the other.
The condition is predominantly a cosmetic problem in terms of the chest wall shape but will also result in breast shape changes in females. Female breast issues can be that the breasts are truly different size and shape but often the breast is just in a different position due to the chest wall abnormality.
Therefore correcting the chest wall can often solve breast asymmetry issues. Occasionally a breast implant is used later to further improve breast appearance.
There is debate about any functional impact on breathing with severe cases of Pectus Excavatum and will be investigated if a concern. Functional problems, if present, are very uncommon.
There are two main treatment choices for Pectus Excavatum.
- Surgical correction of the actual rib cage and sternum by cardiothoracic surgeons. This is procedure is very invasive with breaking of the involved ribs/sternum and insertion of a metal bar that is later removed. Stephen McCulley does not perform this operation.
- Insertion of a custom built silicone implant that sits on top of the indented sternum/ribs but below the chest wall muscles. These purpose-built 3D implants is Stephen McCulley’s preferred method of treating this problem.
Why 3D custom implants and how does it work?
Stephen McCulley has been treating this condition since 2002 but with the traditional methods of creating chest wall casts, wax models and then a silicone implant. This has been replaced by use of more modern technology using 3D CT scans, computer modelling of the required changes, 3D printing an implant and then using this as a template to create a sterile silicone replica for surgical insertion. The scans are done locally and sent to a company in France (www.anatomikmedelling.com) where the 3D print is done and then sent to Sebbin (www.sebbin.com) in Paris who are a long established implant company making high quality breast implants.
The silicone implant used for pectus excavatum is made of a solid but malleable silicone and therefore cannot leak. It is designed to sit on the rib cage replacing the contour deficit of the bones and to be permanent. It takes 10 weeks to produce an implant.
The advantage of this technique is the high success rate and relatively low risks of complications. The chest wall/ribs/sternum is left intact and therefore the serious risks such as lung injuries, pneumothorax (puncture lung), cardiac risks are almost eliminated. Recovery is also much quicker and it is considerably less painful with very few long term issues.
How is the operation performed?
This operation does require a vertical scar in the midline that is 7-8cms long. The chest wall muscles (Pectoralis major) is lifted away from the sternum and ribs as required to create a pocket for the implant. The implant is inserted into this space and the muscles closed over the implant. The implant extends partly to the upper tummy muscles to ensure a smooth appearance is achieved below the rib cage.
Recovery from custom 3D implants
You will be kept for one or occasionally two nights in hospital. You will wake up with a compression garment over your chest and may have a drain.
Time off work – You would require two weeks from a sit down job up to 6 weeks for a manual job.
Driving – You need to be relatively pain free and in control of your car and should avoid driving for 1-4 weeks depending upon size of surgery
Sport and exercise – You will be walking well after first day. Gentle exercise is allowable after first 10 days. High impact sport or stressing of the pectoralis muscles should be avoided for 8 weeks.
Risks of custom 3D implant
- Bleeding – Although much less invasive than other options this still does involve lifting the muscles off the rib cage giving a risk of bleeding in first 24 hours. Although uncommon this would require a return to theatre.
- Infection – Very uncommon but could result in the loss of the implant or a washout procedure.
- Scarring – The midline scar heals very well in most patients. However midline scars can become pink and thickened in some and there is a small risk of long-term hypertrophic or keloid scarring.
- Altered sensation to skin. Usually short term
- Seroma -This is a fluid collection around the implant in the first few weeks after surgery. It is very common even if a drain is used hence many surgeons do not use drains. The fluid is removed with a needle and may need repeating a few times to achieve the final outcome. It is then very rare for it to recur.
- Rotation or movement implant– Very uncommon as implant becomes encased in scar tissue and feels like bone once in place. However is a small risk.
- Replacement of implant – The procedure is designed to be permanent but this has not been used for many decades and therefore there is some risk the implant may be needed if there is evidence of it breaking or weakening over the years.
Costs for custom 3D implant including CT scan, Implant planning and production, Operation and all follow-up requirements; Please ask for quote. As of 2023 prices are £15,100